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No.  I. — Essentials  of  Physiology,  second  Edition.  Illustrated,  Keyised 
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Ann  Arbor;  Corresponding  Member  of  the  Uoyal  Academy  of  Medicine,  Rome, 
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No.  4. — Essentlalsof  Medical  Chemistry,  organic  and  inorganic,  contain- 
ing also  Questions  ou  Medical  Physics.  Chemical  Physiology,  Analytical  Pro- 
cesses, UrinalysisandToxicology.  fouhth  thousand.  IJy  Lawrence  Wolff, M.D., 
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German  Hospital  of  Philadelphia;  Member  of  Philadelphia  College  of  Phar- 
macy, etc.,  etc. 

No.  5. — Essentials  of  Obstetrics,     illustrated,  fourth  thousand.  By  w. 

Easterly  Akhton,  M.  D.,  Demonstfator  of  Clinical  ObstctricHin  the  Jetferson 
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Medical  Hospital,  etc.,  etc. 

No.  6. — Essentials  of   Pathology  and   Morbid   Anatomy,     illustrated. 

By  C.  E.  Ahmand  Kkmple,  H.A.,  M.B.  Cantab.,  L.S.A.,  M.R.C.P.,  Eond.,  Physi- 
cian fo  the  Northeastern  Hospital  for  Children,  llaclcn(;y;  Professor  of  Vocal 
and  Aural  Fhysioh^j^y  and  Examiner  in  Acoustics  at  Trinity  Collogw,  London, 
etc..  etc. 


H$T  QFCOMPENDS.— Continued. 


No.  7. — Essentials  of  Materia  Medica,  Therapeutics  and  Prescription 

Writing.  By  Henuy  Mouris,  M.D.,  late  Demonstrator,  Jefferson  Medical  Col- 
lege; Fellow  College  ot  riiysieians,  Fhiladelplaia;  Co-Editor  Biddle's  Materia 
Medica;  Visiting  Thysician  to  St.  Joseph's  Hospital,  etc.,  etc. 

Nos.  8  and  9. — Essentials  of  Practice  of  Medicine.  (Double  number, 
over  live  hundred  pages.)  IJ.v  Hewky  Moeris,  ,M.D.,  Author  of  Essentials  of 
Materia,  Medica  and  Therapcuiics,  etc.,  etc. 

No.  10. — Essentials  of  Gynaecology,  with  nmnerous  illustrations.  By 
Edwin  B.  Craigin,  M.D.,  Att^'nding  Gyna3cologist,  Hoosevelt  Hospital,  Out- 
patients' Department;   Assistant  Surgeon,  JStew  York  Cancer  Hospital,  etc.,  etc- 

No.  M. — Essentials  of  Diseases  of  the  Skin.     75  illustrations.   By  Henrt 

W.  Stelwagon,  M  1).,  Clinical  Lecturer  on  Dermatology  in  \he  Jefferson  Medical 
College,  Philadelphia;  Physician  to  Philadelphia  Dispensary  lor  Skin  Diseases; 
Chief  of  the  Skin  Dispensary  in  the  Hospital  of  UniArersity  of  Pennsylvania; 
Physician  to  Skin  Department  of  the  Howard  Hospital;  Lecturer  on  Derma- 
tology in  the  Women's  Medical  College,  Philadelphia,  etc.,  etc. 

No.  I2.^ssentials  of  Minor  Surgery  and  Bandaging.  Wiih an  Appen- 
dix on  Venerbal  Diseases.  Illustrated.  By  Edward  Martin.  M.D.,  author  of 
the  "Essentials  of  Surgery,"  etc.,  etc. 

No.  is. — Essentials  of  Legal  Medicine,  Toxicology  and  Hygiene,     one 

hundred  and  thirty  tine  Illustrations,  liy  C.  E.  Armand  Semple,  M.  D.,  Author 
of  "Essentials  of  Pathology /and  Morbid  Anatomy,"  etc.,  etc. 

No.  14. — Essentials  of  the  Refraction  and  Diseases  of  the  Eye.     iiius- 

ti-ated.  By  Edward  Jackson,  A.M.,  M.D.,  Professor  of  Diseases  of  the  Eye  in 
the  Philadelphia  Polvelinic  and  College  for  Graduates  in  Medicine;  Member  of 
the  American  Ophthalmological  Society;  Fellow  of  the  College  of  Physicians 
of  Philadelphia;   Fellow  of  the  American  Academy  of  Medicine,  etc.,  etc.;  and 

Essentials  of  Disease*  of  the  Nose  and  Throa*.  illustrated.  By  E.  Bald- 
win Gleason,  M.D.,  Assistant  in  the  Nose  and  Thj-oat  Dis])ensary  of  the  Hospital 
of  the  University  of  J'ennsylvania;  Assistant  in  the  Nose  imd  Throat  Depart- 
ment of  the  Union  Dispensary;  Member  of  the  Gernian  Medical  Society,  Phila- 
delphia, Polyclinic  Medical  Society,  etc.,  etc. 

No.   15. — Essentials  of  Diseases  of  Children,    illustrated.    By  William 

M,  PowELlr,  M.D.,  Physician  to  theClinic  for  the  Diseases  of  Children  in  the 
Hospital^  of  the  University  of  Pennsylvania;  Examining  Physician  to  the 
Children's  Seashoi'e  House  for  Invalid  Children  at  Atlantic  City,  N;  J.;  form- 
erly Instructor  In  Physical  Diaernosis  in  the  Medical  Department  of  the  Univer- 
sity of  Pennsjylvania,  and  Chief  of  the  Medical  Clinic  of  the  Philadelphia  Poly- 
cliJilc. 

No.  16,— ^Essentials  4i#  Examination  of  Urine,  colored  »  vogel  soalb," 
and  nmnerous  lllusti'att*:\t.  By  Lawrence  Wolfe,  M.D.,  Author  of  "  Essentials 
of  Chemlstiy,"  etc.,  etc.;  price,  75  cents. 

No.  17.  EsSSntialS  of  Diagnosis.  By  David  D.  Stewart,  M.D.,  Lecturer 
on  Diseases  of  the  Nervous  System  at  the  Jefferson  Medical  College ;  Late  Chief 
of  the  Medical  Clinic  Jefferson  Medical  College  Hospital;  Physician  to  St. 
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ber, over  five  hundred  pages.)  By  Henry  Morris,  M.D.,  Author  of  Es- 
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No.  10. — Essentials  of  GynsSCOlogy.  with  numerous  illustrations. 
By  Edwin  B.  Craigin,  M.D.,  Attending  GynEecologist,  Roosevelt  Hos- 
pital, Outpatients  Department;  Assistant  Surgeon  New  York  Cancer 
Hospital,  etc.,  etc. 

No.  11. — Essentials  of  Diseases  of  the  Skin.  75  illustrations.  By 

Henry  W.  Stelwagon,  M.  D.,  Clinical  Lecturer  on  Dermatology  in  the 
Jefferson  Medical  College,  Philadelphia;  Physician  to  Philadelphia  Dis- 
pensary for  Skin  Diseases  ;  Chief  of  the  Skin  Dispensary  in  the  Hospital 
of  University  of  Pennsylvania;  Physician  to  Skin  Department  of  the 
Howard  Hospital;  Lecturer  on  Dermatology  in  the  Women's  Medical 
College,  PhiladeliDhia,  etc.,  etc. 

No.  12.— Essentials  of  Minor  Surgery  and  Bandaging,    with  an 

Appendix  on  Venereal  Diseases.  Illustrated.  By  Edward  Martin, 
M.  D., -author  of  the  "Essentials  of  Surgery,"  etc.,  etc. 

No.  13.— Essentials  of  Legal  Medicine,  Toxicology  and  Hygiene. 

One  hundred  and  thirty  fine  Illustrations.  By  C.  E.  Armand  Semple,  M.D., 
Author  of  "Essentials  of  Pathology  and  Morbid  Anatomy,"  etc.,  etc. 

No.  14. — Essentials  of  the  Refraction  and  Diseases  of  the  Eye. 

Illustrated.  By  Edward  Jackson,  A.M.,  M.D.,  Professor  of  Diseases  of 
the  Eye  in  the  Philadelphia  Polyclinic  and  College  for  Graduates  in  Medi- 
cine ;  Member  of  the  American  Ophthalmol ogical  Society  ;  Fellow  of  the 
College  of  Physicians  of  Philadelphia;  Fellow  of  the  American  Academy 

ofMedicine,etc..etc,,and  Essentials  of  Diseases  of  the  Nose  and  Throat. 
Illustrated.  By  E.  Baldwin  Gleason,  M.  D..  Assistant  in  the  Kose 
and  Throat  Dispensary  of  the  Hospital  of  the  University  of  Pennsylva- 
nia; Assistant  in  the  Jfose  and  Throat  Department  of  the  Unlo'i  Dispen- 
sary; Alember  of  the  German  Medical  Society,  Philadelphia,  Polyclinic 
Society,  etc.,  etc. 

No.  15. — Essentials  of  Diseases  of  Children,  illustrated.  By 
William  M.  Powell,  M.  D.,  Physician  to  the  Clinic  for  the  Diseases  of 
Children  in  the  Hospital  of  the  University  of  Pennsylvania;  Examining 
Physician  to  the  Children's  Seashore  House  for  Invalid  Children,  at  At- 
lantic City,  N.  J. ;  formerly  Instructor  in  Physical  Diagnosis  in  the 
Medical  Department  of  the  tjniversity  of  Pennsylvania,  arid  Chief  of  the 
Medical  Clinic  of  the  Philadelphia  Polyclinic. 

No.  16. — Essentials  of  Examination  of  Urine,  colored  "  Vogei 
Scale,"  and  numerous  Illustrations.  By  Lawrence  Wolff,  M.D.,  authoi 
of  "  Essentials  of  Chemistry,"  etc,,  etc.;  price,  75  cents. 

No.  !7. — Essentials  of  Diagnosis.    By  david  d.  Stewart,  m.  d. 

Lecturer  on  Diseases  of  the  Nervous  System  at  the  Jefferson  Medical 
College;  Late  Chief  of  the  Medical  Clinic  Jefferson  Medical  College  Hoss 
pital ;  Physician  to  St.  Maiy's  and  St.  Christopher's  Hospitals ;  Fellow  of 
the  College  of  Physicians  of  Philadelphia,  etc.,  etc. 

No.    18. — Essentials  of  the    Practice  of  Pharmacy.    By  l.  e. 

Sayre,  Professor  of  Pharmacy  and  Materia  Medica  in  the  University 
of  Kansas. 

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SAUNDERS'  gUESTION-CQMPENDS,  No.  15. 

ESSENTIALS  OF  THE  DISEASES 
OF  CHILDREN, 


ARRANGED  IN  THE  FORM  OF 


QUESTIONS  AND  ANSWERS 


PREPARED  ESPECIALLY  FOR 


STUDENTS  OF  MEDICINE. 


BY 
WILLIAM   M.  POWELL,  M.D., 

PHYSICIAN  TO  THE  CLINIC  FOR  THE  DISEASES  OF    CHILDREN   IN  THE  HOSPITAL  OP  THE 

UNIVERSITY  OF  PENNSYLVANIA  ;    EXAMINING   PHYSICIAN   TO  THE  CHILDREN'S 

SEASHORE   HOUSE   FOR  INVALID  CHILDREN,  AT  ATLANTIC  CITY,  N,  J,; 

FORMERLY   INSTRUCTOR   IN   PHYSICAL   DIAGNOSIS   IN    THE   MEDICAL   DEPARTMENT   OF 

■     THE  UNIVERSITY  OF   PENNSYLVANIA,  AND    CHIEF  OF    THE  MEDICAL 

CLINIC  OF  THE  PHILADELPHIA  POLYCLINIC. 


PHILADELPHIA; 

W.    B.    S  AUN  DE  ES, 

913  Walnut  Srteet. 
1890. 


Entered  according  to  Act  of  Congress  in  the  year  1890,  by 

W.   B.   SAUNDERS, 
In  the  Office  of  the  Librarian  of  Congress,  at  Washington. 


COLLINS  PRINTINQ   HOUSE, 
705  JAYKE  6TKEET. 


TO 

LOUIS   STAEE,  M.D., 

OF  PHILADELPHIA, 
AS   A    SINCERE    TRIBUTE   OF    ADMIRATION    AND   REGARD 


SWS  ioofe 


IS   DEDICATED   BY    HIS   ASSISTANT, 


THE  AUTHOR. 


(iii) 


PREFACE. 


In  presenting  The  Essentials  of  the  Diseases  of 
Children  the  author  wishes  to  state  that  the  substance- 
matter  has  been  chiefly  drawn  from  the  works  of  Eustace 
Smith  of  London;  J.  Lewis  Smith  of  New  York;  Edward 
Ellis  of  New  Zealand;  J.  E.  Goodhart's  American  Edition, 
by  Louis  Starr  of  Philadelphia;  Diseases  of  the  Digestive 
Organs  by  Louis  Starr^  and  Meigs  and  Pepper's  Diseases  of 
Children. 

Being  a  work  of  necessarily  limited  scope,  the  subject  has 

been  discussed  mainly  from  its  symptomatic  and  therapeutical 

standpoints,  the  questions  of  diet,  general  hygiene,  and  nursing, 

while  receiving  their  place,  being  less  fully  considered  than  in 

the  various  books  devoted  to  these  important  branches.     In 

covering  the  provinces  of  symptomatology  and  therapeutics  an 

effort  has  been  made  to  bring  the  book  thoroughly  abreast  of 

the  times. 

W.  M.  POWELL. 


2205  Pine  St.,  Philadelphia. 
September  1,  1890. 

(V) 


CONTENTS. 


Introduction 17 

Part          I.  Dentition       ......  25 

Part        II.  Diseases  of  the  mouth  and  throat    .         .  28 

Part      III.  Diseases  of  the  stomach  and  intestines     .  43 

Part       IV.  Diseases  of  the  liver       ....  74 

Part         V,  Diseases  of  the  peritoneum     ...  81 

Part       VI.  Acute  infectious  diseases          ...  85 

Part     VII.  General  diseases  not  infectious         .         .110 

Part  VIII.  The  diathetic  diseases     .         .        '.         .118 

Part       IX.  Diseases  of  the  spleen  and  blood     .         .  124 

Part         X.  Diseases  of  the  nervous  system        .         .  130 

Part       XI.  Diseases  of  the  organs  of  respiration        .  157 

Part     XII.  Diseases  of  the  heart      ....  186 

Part  XIII.  Diseases  of  the  genito-uri nary  organs       .  193 

Part   XIV.  Diseases  of  the  skin        ....  200 

(vii) 


ESSEx^TIALS  OF  DISEASES  OF  CHILDREN. 


Introduction. 

Medical  Examination. 

When  is  the  best  time  to  examine  a  child  ? 

While  it  is  sleeping. 

Why? 

In  order  that  the  pulse  may  be  counted,  the  breathing,  state 
of  the  skin,  and  general  posture  noted. 

What  other  points  should  be  noticed  before  arousing  it  ? 

The  attitude,  the  posture,  if  natural ;  the  color  of  the  face, 
whether  flushed  or  pale ;  the  lips,  if  pale  or  tinted ;  the  skin, 
if  dry  or  moist ;  the  general  expression,  if  natural  or  painful ; 
the  presence  or  absence  of  moaning,  starting,  grinding  of  the 
teeth ;  the  movements  of  the  nostrils,  if  quiet  or  working 
strongly;  the  eyes  if  closed,  partly  closed,  or  staring  should 
be  carefully  observed.  The  respirations  should  be  counted ; 
the  condition  of  the  fontanelle  must  be  carefully  examined,  if 
closed  or  open,  if  pulsating  greatly,  if  distended  or  retracted ; 
the  pulse  should  be  taken,  the  size  and  shape  of  the  head  should 
be  noted,  if  large,  and  whether  the  veins  are  full. 

What  should  be  noticed  after  the  child  is  aroused  ? 

The  expression  of  the  face  ;  whether  it  is  fretful  or  languid  ; 
excited  or  quiet ;   if  it  has  dark  circles  under  the  eyes  ;  the 
color  and  shape  of  the  face,  and  the  presence  or  absence  of 
snuffling. 
2 


18  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

How  long  should  a  perfectly  healthy  infant  sleep  1 

At  least  eighteen  out  of  the  twenty-four  hours.  It  is  useful 
in  fixing  the  period  of  the  commencement  of  an  illness  to  inquire 
when  the  child  was  first  sleepless. 

What  next  should  be  dene  ? 

The  child  should  be  stripped  near  the  fire  and  out  of  the  way 
of  any  draught. 

How  should  the  healthy  skin  appear? 

It  should  be  mottled,  not  flabby  ;  the  limbs  should  move 
freely. 

What  other  important  points  should  be  noted? 

The  joints  should  be  carefully  examined,  whether  large, 
small,  or  swollen.  Eruptions  should  be  looked  for  about  the 
anus,  and  the  penis  carefully  examined  for  adhesions  or  phimo- 
sis, etc. 

What  is  the  number  of  respirations  in  a  healthy  child  ? 

They  range  as  follows  : — 

From  two  months  to  two  years  the  average  is  35  per  minute. 

Under  one  year  the  respirations  vary  from  40  to  50  per 
minute.  From  the  second  to  the  twelfth  year  about  18  per 
minute. 

When  is  the  best  time  to  look  at  the  tongue? 

While  the  child  is  crying,  if  the  child  is  quiet  the  under  lip 
may  be  gently  pressed  by  the  physician's  finger  and  it  will 
protrude  it. 

How  shall  we  examine  the  throat? 

By  placing  the  child  on  the  nurse's  lap  with  its  head  resting 
against  her  breast  and  gently  depressing  the  tongue  with  a 
small  spoon  or  tongue  depressor,  at  times  force  may  have  to  be 
used,  but  if  the  child  is  old  enough  to  understand,  a  little  coax- 
ing and  kindness  will  generally  suffice. 


INTRODUCTION. 


19 


How  should  the  gums  be  examined? 

By  placing  the  child's  head  between  your  knees  and  allow- 
ing its  body  to  remain  in  the  nurse's  lap,  thus  you  have  perfect 
control  over  the  child's  head  should  lancing  be  required. 

How  and  when  should  auscultation  be  practised  ? 

Always  before  percussion,  as  the  latter  usually  excites  the 
child.  The  back  of  the  chest  is  the  most  important  part  to 
auscultate  in  a  child.  If  it  is  found  free  from  the  physical 
signs  of  pneumonia,  bronchitis,  etc.,  we  may  presume  that  the 
front  of  the  chest  is  the  same,  although  if  the  child  be  quiet  it 
is  best  to  auscultate  both  posteriorly  and  anteriorly. 

How  should  percussion  be  practised? 

By  a  light  tap  with  one  or  two  fingers  of  the  right  hand  upon 
a  finger  of  the  left  placed  fiat  upon  the  chest. 

How  should  the  abdomen  be  examined? 

By  palpation  with  the  warmed  hand.  In  this  way  enlarge- 
ments of  the  spleen  or  liver  are  detected  and  other  abdominal 
tumors. 

In  what  position  should  the  child  be  placed  during  the  palpa- 
tion? 

Upon  its  back,  if  possible,  with  its  knees  flexed  so  as  to 
relax  the  abdominal  muscles,  but  this  is  often  impossible,  then 
the  next  plan  is  to  have  the  child  placed  on  the  nurse's  lap  in 
a  sitting  posture  and  slip  the  warmed  hand  beneath  the  clothes. 

Describe  the  expression  of  countenance  indicative  of  disease. 

The  upper  part  of  the  face  is  chiefly  affected  in  diseases  of 
the  brain  causing  the  brow  to  knit,  the  forehead  to  contract, 
and  the  eyes  to  roll. 

What  diseases  affect  the  middle  portion  of  the  face  ? 

Cardiac  and  lung  affections,  the  nostrils  are  sharp  or  dis- 
tended, the  lips  are  pale  or  even  bluish  in  color,  and  dark  rings 
are  under  the  eyes. 


20  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  diseases  affect  the  lower  portion  of  the  face? 

Abdominal  troubles,  the  cheeks  are  changed  in  color,  even 
sunken,  the  mouth  is  drawn,  the  lips  livid  or  pale. 

What  other  important  signs  should  be  noticed  ? 

Redness  or  pallor,  ptosis,  unequal  dilatation  of  the  pupils,  etc. 

What  gestures  usually  point  to  disease  of  the  brain  ? 

Hands  constantly  to  the  head,  pulling  at  the  hair,  rolling  or 
burying  head  in  the  pillow. 

What  gestures  signify  abdominal  disease? 

The  legs  are  drawn  up,  the  face  is  anxious  and  sunken,  the 
child  picks  at  the  bed-clothes. 

What  gestures  point  to  dyspnoea  ? 

Child  tears  at  its  throat  or  puts  its  hand  in  its  mouth,  espe- 
cially in  diphtheria  and  croup,  when  false  membranes  are  form- 
ino;. 

What  is  the  character  of  the  cry  in  pneumonia  and  capillary 
bronchitis  ? 

Labored,  as  if  half  suffocated. 

In  croup? 

Brassy  and  metallic,  with  crowing  inspirations. 

In  cerebral  disease  ? 

Sharp,  shrill,  and  solitary,  i.  e.,  the  so-called  "  cri  hydro- 
c^phalique.^^ 

In  marasmus  and  tubercular  meningitis  ? 

Moaning  and  wailing  are  usually  present. 

What  does  obstinate  and  long-continued  crying  usually  denote  ? 

Either  earache  or  hunger. 

When  are  the  tears  and  saliva  usually  secreted? 

About  the  third  or  fourth  month. 

What  does  squinting  of  the  eyes  in  acute  illness  denote? 
Either  reflex  irritation,  paralysis  or  convulsions. 


INTRODUCTION.  21 

What  do  small  pupils  usually  denote  ? 

They  occur  in  active  congestion,  opium  poisoning,  and  in 
sleep. 

Give  the  chief  indications  obtained  from  observation  of  the 
tongue. 

A  furred  tongue  with  spots  of  curd  over  its  surface  indicates 
dyspepsia  and  intestinal  irritation. 

A  red,  hot,  and  dry  tongue  would  point  to  an  inflammation 
of  the  mouth,  stomach,  etc. 

A  pale  flabby  tongue,  marked  at  the  edges  with  the  teeth, 
denotes  great  debility. 

A  heavy  white  fur  is  usually  indicative  of  fever.  Yellow 
fur,  of  liver  and  stomach  trouble.  Brown  fur,  a  low  typhoid 
condition.     Strawberry  tongue,  scarlatina. 


Fecal  Evacuations. 

Describe  the  stools  of  a  healthy  infant. 

They  vary  in  color  from  a  light  to  a  greenish-yellow,  and 
are  of  the  consistency  of  mixed  mustard.  The  reaction  is  acid, 
odor  sour. 

How  many  stools  should  a  healthy  child  have  in  the  twenty- 
four  hours  ? 

For  the  first  few  weeks  three ;  from  then  on  to  the  second 
year  two. 

What  does  the  presence  of  curds  denote  in  the  stools  ? 

Indigestion. 

Describe  the  stools  in  intestinal  catarrh. 

They  are  scanty,  lumpy,  dark  in  color,  and  mixed  with 
mucus. 

What  do  clay-colored  movements  denote? 
An  inactive  liver. 


22  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  does  a  stool  composed  of  blood,  clots,  and  shreds  of 
mucous  membrane  indicate? 
Intestinal  infiammation,  typhoid  fever,  dysentery,  and  tuber- 
cular disease. 

What  is  the  Spinach  stool  ?   ' 

It  is  a  green  evacuation  commonly  found  in  acuto  and  sub- 
acute diarrhoea  in  infants.  M.  Hayem  believes  the  green  color 
is  produced  by  a  particular  bacillus  which  he  considers  conta- 
gious. 

What  is  the  oily  matter  found  in  stools  due  to? 

Probably  to  defective  action  of  the  liver,  pancreas,  and 
intestinal  glands.  The  fatty  matters  of  the  food  are  not  pro- 
perly emulsified,  and,  therefore,  not  absorbed. 

What  does  the  presence  of  mucus  indicate  ? 
Acute  diarrhoea  or  mucous  disease. 

Vomiting. 

How  may  vomiting  be  classified  ? 
Inlo  three  groups  : — 

The  vomiting  of  nurslings, 
The  vomiting  of  older  children, 
Reflex  vomiting. 

Describe  the  vomiting  of  nurslings. 

It  is  caused  by  the  shape  of  the  stomach  being  less  curved 
than  in  the  adult.  It  is  not  a  sign  of  disease,  and  it  is  especi- 
ally found  in  children  that  have  been  nursed  by  an  abundant 
breast.  This  vomiting  is  easily  distinguished  from  that  de- 
pending upon  disease,  as  milk  alone  is  ejected,  although  it  may. 
be  slightly  curdled. 

Describe  the  vomiting  of  older  children. 

This  is  commonly  due  to  indigestion.  Sudden  vomiting  in 
a  child  of  previously  good  health  would  point  to  the  onset  of 


INTRODUCTION.  23 

some  acute  disease,  particularly  scarlet  fever.  Occasionally  in 
girls  it  is  the  development  of  symptoms  well  known  in  young 
adult  females  as  the  outcome  of  hysteria. 

Describe  reflex  vomiting. 

It  may  be  due  to  meningitis,  or  tumor  of  the  brain,  chronic 
disease  of  the  lungs,  pertussis,  dentition,  or  worms. 

The  Pulse. 

What  is  the  pulse  beat  of  a  healthy  infant  ? 

It  ranges  from  90  to  140  beats  per  minute.  It  is  quicker  in 
the  female  than  in  the  male  after  the  seventh  year.  It  is  much 
slower  during  sleep. 

Tlie  following  valuable  table  of  the  pulse  is  given  by  Miiller. 

At  birth 130-140 

1st  year 115-130 

2d      " 100-115 

3d      " 90-100 

7th     " 85-90 

14th     " 80-85 


The  Temperature. 

What  is  the  normal  temperature  of  a  healthy  infant  ? 

At  twenty-four  hours  after  birth  the  average  temperature  is 
100.4°  Fahr.,  at  forty-eight  hours  after  about  98.6°  Fahr. 
After  tliis  it  fluctuates  between  98°  Fahr.  and  99.5°  Fahr. 

How  should  the  temperature  be  taken  ? 

Never  trust  to  your  hand,  but  always  use  a  fever  thermo- 
meter. In  young  infants  it  is  best  taken  in  the  rectum  or 
groin ;  in  older  children  the  mouth  or  axilla  may  be  used. 

What  is  the  weight  of  a  new-born  child? 

Seven  pounds  ;  the  extremes  are  from  lour  to  eleven  pounds. 


24  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

"What  is  the  average  length  of  a  new-born  child  ? 

Nineteen  inches  and  a  fraction  over ;  the  extremes  are  from 
sixteen  to  twenty-two  inches. 

What  are  the  chief  anatomical  peculiarities  of  the  new-born 
child? 
It  has  a  small  stomach  ;  its  intestinal  action  is  more  rapid ; 
its  power  of  generating  heat  is  small ;   its  heart,  brain,  and 
liver  are  large. 

How  should  the  dosage  be  proportioned  for  children? 

The  proportionate  dose  for  any  age  under  adult  life  is  repre- 
sented by  the  number  of  the  following  birthday,  divided  by 
twenty-four,  i.  e.,  for  one  year  ^^  =  J^,  for  two  years  25  =  i 
and  so  on. 


DENTITION.  25 

PART   I. 

Dentition. 

State  the  number  of  milk  teeth. 

Twenty. 

Name  them. 

Two  lower  and  four  upper  central  incisors,  two  lower  lateral 
incisors,  four  anterior  molars,  four  canines,  and  four  posterior 
molars. 

In  what  order  are  they  cut  ? 

The  two  lower  central  incisors  from  the  fourth  to  the  seventh 
month;  the  four  upper  incisors  from  the  eighth  to  the  tenth 
month  ;  the  two  lower  lateral  incisors  and  the  four  anterior 
molars  from  tlie  twelfth  to  the  fifteenth  month  ;  the  four  canines 
from  the  eighteenth  to  the  twenty-fourth  month,  and  the  poste- 
rior molars  from  the  twentieth  to  the  thirtieth  month. 

What  is  the  infant's  condition  during  dentition? 

It  is  usually  the  cause  of  many  ailments,  such  as  fever, 
vomiting,  diarrhoea,  indigestion,  convulsions,  etc. 

How  should  they  be  treated  ? 

The  child's  general  health  should  be  most  carefully  looked 
into,  the  bowels  regulated,  the  diet  cautiously  looked  after, 
and  the  gums  lanced  over  the  advancing  teeth  when  hot  and 
swollen.  The  diarrhoea  of  teething  is  natural,  and  without  it 
is  very  excessive  it  should  not  be  treated.  If  it  causes  griping 
and  is  offensive  the  best  remedy  is  a  teaspoonful  of  castor  oil, 
which  will  clear  away  any  undigested  food.  Never  use  astrin- 
gents in  these  cases.  The  fever  should  be  treated  with  one- 
half  drop  doses  of  tr.  aconite,  any  suspicious  twitching  must 
be  controlled  with  bromide  of  potassium. 


26  ESSENTIALS    OP^    DISEASES    OF    CHILDREN. 

State  the  number  of  permanent  teeth. 
Thirty-two. 

Name  them. 

Four  central  incisors  of  upper  and  lower  jaw ;  four  lateral 
incisors,  four  first  bicuspids,  four  canines,  four  second  bicuspids, 
four  first  molars,  four  second  naolars,  and  the  four  third  molars. 

In  what  order  are  they  cut  ? 

The  two  central  incisors  of  the  lower  jaw  from  the  sixth  to 
the  eighth  year. 

The  two  central  incisors  of  the  upper  jaw  from  the  seventh 
to  the  eighth  year. 

The  four  lateral  incisors  from  the  eighth  to  the  ninth  year. 

The  four  first  bicuspids  from  the  ninth  to  the  tenth  year. 

The  four  canines  from  the  tenth  to  tlie  eleventh  year. 

The  four  second  bicuspids  from  the  twelfth  to  the  thirteenth 
year. 

These  replace  the  temporary  teeth ;  those  which  are  devel- 
oped de  novo  appear  thus  : — 

The  four  first  molars  from  the  sixth  to  the  seventh  year. 

The  four  second  molars  from  the  twelfth  to  the  thirteenth 
year. 

The  four  third  molars  from  the  seventeenth  to  the  twenty- 
first  year. 

How  is  the  general  health  during  second  dentition  ? 

Not  quite  up  to  par,  although  the  child  may  apparently  look 
well  he  will  complain  of  feeling  tired.  Dr.  Louis  Starr  has 
frequently  seen  cervical  adenitis  due  to  the  eruption  of  the  fifth 
year  molars,  which  quickly  subsided  when  the  swollen  gums 
were  lanced. 

How  should  the  child  be  treated  ? 

By  a  careful  diet,  plenty  of  fresh  air  and  out-door  exercise, 
and  if  appetite  be  poor  the  following  tonic  may  be  given : — 


DENTITION.  27 

;^.     Tr.  Nucis  Vomicae  Ti^xxiv-xxxvi. 
Elix.  Calicayse  q.  s.  ad  f^iij. — M. 
Sig.  Teaspoonful  in  water  three  times  a  day  after  eating.     (For  a 
child  from  6  to  8  years  of  age.) 

The    gums    should   be  examined  frequently,  and  if  found 
swollen  and  tense  be  lanced  freely. 


28  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

PART   II. 

Diseases  of  the  Mouth  and  Throat. 
Stomatitis. 

Name  the  several  forms  of  stomatitis. 

Catarrhal  stomatitis. 
Aphthous  stomatitis. 
Ulcerative  stomatitis. 
Parasitic  stomatitis. 
Gangrenous  stomatitis. 

Describe  catarrhal  stomatitis. 

It  consists  of  a  simple  hyperaemia  of  the  mucous  membrane 
of  the  mouth,  accompanied  by  redness  and  swelling.  The  in- 
flammation varies  in  extent  and  degree.  It  may  be  limited  to 
small,  circumscribed  points  of  the  membrane,  or  extend  over 
large  patches  involving  the  entire  surface.  In  severe  cases 
the  mucous  glands  of  the  lips  and  cheeks  are  involved,  and 
become  enlarged. 

The  disease  may  be  primary  or  secondary. 

What  are  the  causes  of  the  primary  form  ? 

Any  food  or  liquid  that  is  irritating ;  teething,  improper 
care  of  the  child's  mouth  ;  exposure  to  cold  and  wet ;  bad 
hygiene,  and  the  administration  of  certain  drugs,  as  mercury, 
iodine,  and  arsenic. 

What  are  the  causes  of  the  secondary  form  ? 

The  secondary  form  usually  occurs  during  the  course  of  one 
of  the  eruptive  fevers,  and  any  disordered  conditions  of  the 
stomach,  especially  those  attended  by  acid  eructations. 

At  what  age  does  it  usually  occur  ? 

Although  not  limited  to  any  particular  age  the  disease  usu- 
ally occurs  during  dentition. 


DISEASES    OF    THE    MOUTH    AND    THROAT.  29 

What  are  the  symptoms  ? 

The  lips  are  unusually  full  and  red,  the  skin  at  the  angles 
of  the  mouth  is  excoriated  from  dribbling  saliva.  The  mucous 
membrane  of  the  mouth  shows  either  a  punctated,  patchy, 
or  diffuse  redness,  and  is  much  swollen  and  tender  to  the 
touch.  The  mouth  at  first  is  dry,  but  soon  the  salivary  flow  is 
increased,  which  becomes  acid  in  reaction,  and  at  times  viscid 
and  flocculent.  The  mucous  glands  of  the  cheeks  and  lips 
project  as  pearly  white  nodules.  The  tongue  is  either  red  and 
smooth  with  enlarged  fungiform  papillae,  or  covered  with  a 
■white  frosting  through  which  the  papillae  project  in  red  points. 
Sucking  and  eating  are  painful.  The  child  is  restless,  the  skin 
hot,  anorexia  depending  upon  the  local  tenderness,  and  con- 
stipation are  the  general  symptoms  of  the  primary  form. 

The  symptoms  of  the  secondary  form  depend  upon  the  origi- 
nating disease ;  the  local  symptoms  remain  the  same. 

What  is  the  duration  of  the  disease  ? 

The  course  of  the  disease  rarely  lasts  longer  than  a  week. 

What  is  the  treatment  ? 

After  removing  the  exciting  cause,  the  mouth  at  first  should 
be  carefully  washed  with  pure  water ;  the  gums  should  be 
lanced  if  hot  and  swollen.  The  mouth  should  be  washed  with 
one  of  the  following  solutions  and  the  bowels  kept  freely  opened 
by  appropriate  drugs  : — 

^.     Potass.  Chlorat.  gr.  x. 
Listerine  5ij- 
Aquse  q.  s.  ad  f  §j. — M. 
Sig.  Mouth-wash. 

^.     Potass.  lodid.  gr.  iij. 
Glycerinse  5ij* 
AqujE  Rosse  q.  s.  ad  §j. — M. 
Slg.  Use  locally. 

Salicylic  acid,  one  j)art  (dissolved  in  alcohol)  to  250  parts  of 
water  is  said  to  ease  the  pain. 


30  ESSENTIALS    OF    DISEASES    OF    CIIILDIiEN. 

Aphthous  Stomatitis. 

Describe  this  form. 

In  this  disease  a  number  of  small  ulcers  appear  upon  the 
inflamed  and  swollen  mucous  membrane  of  the  lips,  tongue, 
gums,  and  cheeks.  They  are  round  or  oval,  slightly  depressed. 
Their  color  in  the  centre  is  a  yellowish-white  surrounded  by  a 
band  of  deep  redness.  They  may  run  together  and  form  large 
ulcers.     The  disease  may  occur  at  any  age. 

What  are  the  causes? 

Insufficient  or  improper  food  ;  ill-ventilated  houses  ;  chronic 
disease  of  the  digestive  tract,  scrofula,  etc. 

What  are  the  symptoms? 

The  previous  day  the  child  is  restless  and  fretful,  the  mouth 
is  hot  and  tender,  the  tongue  heavily  coated,  the  salivary  flow 
is  greatly  increased,  and  the  ulcers  form. 

What  is  the  course  of  the  disease? 

The  ulcers  last  from  three  to  twelve  days  in  mild  cases  ;  in 
severe  cases  the  pharynx,  hard  and  soft  palate  may  be  involved. 

What  is  the  treatment? 

First,  regulate  the  diet  and  give  a  moderate  dose  of  calomel, 
which  may  be  followed  by  a  course  of  pepsin,  with  dilute 
muriatic  acid,  if  there  be  much  gastric  trouble.  Locally  a 
wash  of  chlorate  of  potash  or  borax  may  be  used  (gr.  x  to  f  Jj) 
every  hour  or  two.  Should  the  ulcers  be  obstinate  in  healing 
they  may  be  touched  once  daily  with  a  strong  solution  of 
nitrate  of  silver,  or  even  W'ith  a  point  of  lunar  caustic. 

Ulcerative  Stomatitis. 

Describe  this  form. 

It  is  usually  seen  in  children  between  the  ages  of  three  and 
eight  years,  and  never  before  the  commencement  of  dentition. 


DISEASES    OF    THE    MOUTH    AND    THROAT.  31 

Unlike  the  other  forms  just  mentioned,  the  ulceration  is  a 
rapidly-spreading  one.  The  lower  jaw  is  said  to  be  more 
frequently  affected  than  the  upper.  The  mucous  membrane 
becomes  red  and  swollen  ;  the  gums  are  tender  and  bleed  on 
the  slightest  touch;  the  edges  of  the  gums  in  contact  with  the 
teeth  turn  a  dirty  yellowish  gray,  soften,  and  break  down  ; 
the  teeth  are  loosened,  and  sometimes  the  periosteum  is  de- 
stroyed and  necrosis  takes  place. 

What  are  the  causes? 

Insufficient  or  bad  food;  cold,  damp,  or  badly-ventilated 
houses.  It  may  follow  any  of  the  eruptive  fevers,  dysentery, 
and  scrofula.  The  presence  of  decaying  teeth,  and  the  careless 
administration  of  drugs — such  as  mercury,  lead,  and  phos- 
phorus— often  excite  it. 

What  are  the  symptoms? 

The  mouth  is  hot  and  dry,  tongue  coated,  and  the  breath 
very  offensive  ;  the  saliva  becomes  streaked  with  blood,  and  is 
very  profuse ;  mastication  is  the  cause  of  much  pain  ;  the  sub- 
maxillary and  lymphatic  glands  of  the  neck  are  generally 
swollen,  and  the  face  may  be  oedematous.  The  child  is  much 
debilitated,  fretful,  and  sleepless.  The  ulceration  usually  ap- 
pears on  the  external  surface  of  the  lower  gum,  at  first  spread- 
ing to  the  upper  gum,  the  edges  of  the  tongue,  and  lastly  on 
the  cheeks.  The  ulcers  are  of  a  dirty  gray  color,  depressed 
with  red,  swollen  edges. 

What  is  the  diagnosis? 

The  general  appearance  of  the  gums  before  ulceration  com- 
mences, the  character  of  the  ulcers,  the  odor  of  tlie  breath, 
distinguish  this  disease  from  any  others  of  the  mouth. 

What  is  the  prognosis? 

It  is  usually  good.  Should  necrosis  of  the  jaw  occur  the 
duration  is  much  prolonged,  but  recovery  is  generally  the  rule; 


32  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

intercurrent  noma,  however,  often  leads   to  the  death  of  the 
child. 

What  is  the  treatment? 

First  improve  the  sanitary  surroundings  ;  secure  cleanliness, 
fresh  air,  and  sunlight ;  a  diet  of  animal  broths  and  milk 
may  be  given.  Chlorate  of  potash,  either  alone  or  with  dilute 
muriatic  acid,  should  be  administered. 

J^.     Potass.  Chlorat.  gr.  xlviij. 
Acid.  Muriat.  dil.  f  5j- 
Sjrupi  f^ss. 
Aquae  q.  s.  ad  f  ^iij- — M« 
Sio-.  Teaspoonful  diluted  every  two  hours  for  a  child  three  years  old. 

(Star?-.) 

The  following  wash  is  recommended  by  the  same  author  : — 

;^.     Potass.  Chlorat.  gr.  Ixxx. 
Acid.  Carbol.  gr.  ij. 
Glycerinse  f^j. 
Aquae  q.  s.  ad  f^viij. — M. 
Sig.  Thoroughly  apply  to  ulcers  twice  daily,  and  use  as  mouth-wash. 

When  the  ulceration  covers  much  surface  it  should  be 
swabbed  by  the  physician  with  a  saturated  solution  of  perman- 
ganate of  potassium  daily;  half  a  teaspoonful  of  Condy's  fluid  to 
a  pint  of  water  should  also  be  used  as  a  mouth-wash.  Loose 
teeth  ought  not  be  disturbed  without  they  retard  the  heal- 
in  c^  of  the  sores.  After  the  ulcers  have  healed  the  local 
treatment  may  be  discontinued,  and  the  child  put  on  tonics, 
stimulants,  etc. 

Thrush  (Parasitic  Stomatitis.) 

Describe  the  condition  of  the  mouth. 

The  mucous  membrane  of  the  mouth  is  covered  with  small 
white  flakes,  resembling  minute  pieces  of  curd.  They  are  most 
abundant  in  the  buccal   mucous    membrane,  the  tongue  and 


DISEASES    OF    THE    MOUTH    AND    THKOAT.  33 

fauces  ;  occasionally  they  extend  to  other  parts  of  the  digestive 
tract,  namely,  the  oesophagus,  stomach,  and  intestines.  -These 
spots  are  due  to  the  development  of  a  vegetable  parasite,  the 
o'idium  albicans. 

"What  are  the  causes? 

Improper  food,  bad  hygiene,  dirty  nursing-bottles,  tips,  etc. 
It  never  attacks  infants  nursed  at  the  breast. 
What  is  the  pathological  anatomy? 

Before  the  flakes  appear  the  mucous  membrane  of  the  mouth 
is  purplish-red  in  color,  the  secretion  is  acid  in  reaction  ;  the 
latter  shows  under  the  microscope  many  spores,  oval  in  shape, 
sharply  outlined,  and  hanging  together  in  twos  and  threes; 
some  white  points  appear  on  the  buccal  mucous  membrane, 
which  rapidly  increase  in  extent  and  number ;  about  the  third 
day  these  coalesce  and  form  white  flakes ;  during  the  first 
few  days  they  adhere  firmly  to  the  mucous  membrane,  after- 
wards they  become  loose  and  can  easily  be  wiped  off.  The 
fungus  grows  only  upon  squamous  epithelium. 

"What  are  the  symptoms? 

The  mucous  membrane  of  the  mouth  is  dry,  tender,  slightly 
swollen,  and  red  ;  the  child  is  fretful  and  restless,  the  stools 
are  usually  loose  and  yellow  in  color.  In  twenty-four  hours 
the  thrush  patches  appear,  first  on  the  buccal  mucous  mem- 
brane, finally  reaching  the  lips,  tongue,  and  palate.  When  the 
patches  appear  there  is  increased  fretfulness,  much  pain  on 
sucking,  occasional  vomiting,  and  the  passage  of  greenish 
stools.  In  from  six  to  twelve  days  from  the  beginning  of  the 
disease  the  patches  become  loose  and  are  removed  by  suitable 
applications  and  the  act  of  sucking ;  the  mucous  membrane  is 
left  red  and  free  from  ulceration,  and  soon  returns  to  its 
normal  condition.  In  the  secondary  form  a  previous  history 
of  some  gastro-intestinal  trouble  is  usually  obtained.  The  pre- 
liminary catarrh  of  the  mouth  is  very  marked,  the  mucous 
3 


oi  ESSENTIALS    OF    DISEASES    OF    CHILDKEN. 

membrane  being  intensely  red  and  shining ;  the  patches  are 
much  -thicker,  and  adhere  more  firmly  than  in  the  primary 
form  ;  when  they  are  removed  or  fall  off  they  are  quickly  re- 
placed by  others  up  to  the  termination  of  the  case  in  death. 
There  may  be  either  occasional  or  constant  vomiting,  obstinate 
diarrhcea,  the  stools' being  acid,  and  green  in  color;  distended 
abdomen,  colic,  etc.  ;  the  skin  becomes  pale  and  flabby,  the 
anterior  fontanelle  sinks,  and  the  child  has  scarcely  enough 
strength  to  cry,  and  death  from  atrophy  soon  follows. 

What  is  the  diagnosis? 

When  the  curd  is  wiped  away  the  mucous  membrane  is 
found  in  its  normal  condition,  a  characteristic  distinction  of 
this  disease.  Aphthous  stomatitis  slightly  resembles  thrush, 
but  the  differentiation  is  made  by  noting  that  the  yellowish- 
white  spots  of  the  former  are  depressed  below  the  surface  of 
the  mucous  membrane  and  are  bounded  by  dark -red  borders. 
Microscopic  examination  is  always  a  positive  test,  and  the 
presence  or  absence  of  the  parasite  decides  the  question. 

"What  is  the  prognosis  1 

The  primary  form  usually  ends  in  recovery.  The  secondary 
form  is  unfavorable. 

What  is  the  treatment  ? 

Wash  out  the  child's  mouth  after  each  meal.  See  that  the 
nursing-bottles,  tips,  etc.,  are  kept  absolutely  clean.  The  diet 
should  be  carefully  regulated  as  regards  quantity  and  quality 
of  the  food,  and  the  intervals  of  feeding,  etc. 

The  local  treatment  consists  of  keeping  the  mouth  perfectly 
clean  by  washing  it  every  hour  with  warm  water,  using  a  soft 
rag  wrapped  around  the  finger,  after  which  one  of  the  following 
washes  may  be  applied  either  with  a  camel's-hair  brush  or  clean 
piece  of  rag,  which  should  be  destroyed  after  using. 

I^.     Grlycer'.  Boracis  §j. 
Sig.  Use  locally. 


DISEASES    OF    THE    MOUTH    AND    THROAT.  35 

^..     Potass.  Chloral.   5ss. 
Grlycerinse, 
Listerine,  aa  ^ss. 
Aquse  q.  s.  ad  i'^ij. — M. 
Sig.  Use  locally. 

]^.     Sodii  Salicylat, 

Sodii  Borat.,  aa  gr.  x. 
Acid.  Carbol.  gr.  j. 
Grlycerinse  5ij- 

Aquse  Rosse  q.  s.  ad  f  fj. — M. 
Sig.  Use  locally.      (Starr.) 

In  secondary  thrush  the  same  treatment  is  applicable. 
Appropriate  drugs  should  be  employed  to  check  the  vomiting 
and  diarrhoea,  maintain  the  strength,  and  improve  the  diges- 
tive pow^ers. 

Gangrenous  Stomatitis  or  Noma. 

Describe  this  disease. 

The  affection  usually  commences  with  fetor  of  the  breath 
followed  by  a  free  flow  of  saliva,  which  is  very  offensive.  On 
examination  a  hard  red,  shining  swelling  is  seen  upon  one 
cheek,  not  painful,  but  very  tense.  Inside  the  mouth  at  a 
point  corresponding  to  the  swelling  a  large  excavated  and 
ragged  ulcer  is  seen  covered  with  a  brown  slough,  from  which 
a  putrid  discharge  oozes.  This  ulcer  is  phagedgenic  in  char- 
acter, it  involves  the  gums,  teeth,  and  destroys  tissues. 
Necrosis  of  the  jaw  and  perforation  of  the  cheek  may  occur; 
deglutition  is  not  generally  interfered  with. 

What  are  the  causes  ? 

It  is  always  secondary,  following  severe  maladies,  such  as 
small-pox,  scarlet  fever,  measles,  wliooping-cough,  ulcerative 
stomatitis,  and  tuberculosis.  It  occurs  between  the  ages  of  two 
and  twelve  years.  Girls  are  said  to  be  more  susceptible  than 
boys.     It  is  not  contagious. 


B6  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  are  the  symptoms  ? 

At  the  onset  there  are  few  constitutional  symptoms,  and  the 
child  rarely  complains  of  pain.  As  the  ulcer  spreads  constitu- 
tional depression  sets  in.  The  face  becomes  pale,  the  pulse 
frequent,  120  to  150  beats  to  the  minute  ;  the  mouth  is  held 
partly  open,  the  tongue  and  teeth  are  covered  with  sordes ;  the 
breath  is  fetid,  and  there  is  a  large  flow  of  offensive  saliva  of 
a  brownish  color  streaked  with  blood.  The  appetite  usually 
remains  good  and  the  bowels  are  inclined  to  be  loose.  Per- 
foration of  the  cheek  may  occur  at  any  time  between  the 
third  and  tenth  day.  The  gangrene  may  invade  the  lips,  the 
ala  of  the  nose  on  the  affected  side,  and  the  cheeks  as  far  as  the 
lower  eyelids.  The  gums  and  periosteum  of  the  jaws  are 
destroyed,  and  necrosis  of  the  jaw,  and  looseness  of  the  teeth 
occur. 

What  is  the  dis  gnosis  ? 

In  cases  of  noma,  where  the  ulceration  precedes  the  gan- 
grene, it  may  be  mistaken  for  ulcerative  stomatitis  although 
in  the  former,  around  the  ulcer  where  the  gangrene  commences, 
the  tissues  are  very  much  thickened  and  indurated ;  while 
the  latter  begins  with  a  submucous  deposit  of  fibrin  attended 
with  little  thickeningr  and  induration.  In  ulcerative  stomatitis 
the  skin  over  the  affected  part  is  normal  in  appearance,  in 
noma  it  is  tense  and  shining. 

It  may  be  mistaken  for  malignant  pustule  although  this 
disease  is  rarely  found  in  children.  The  pustule  always  begins 
on  the  skin,  while  noma  is  primarily  a  disease  of  the  mucous 
membrane. 

What  is  the  prognosis  ? 

Very  unfavorable — 75  per  cent,  of  the  cases  die.  Death  may 
occur  at  any  time  between  the  third  and  fourteenth  day.  If 
recovery  takes  place  the  patient  is  disfigured  by  scars,  loss  of 
teeth,  and  probably  portions  of  the  maxillary  bone. 


DISEASES    OF    THE    MOUTH    AND    THROAT.  37 

What  is  the  treatment  ? 

Have  the  sick  room  thoroughly  ventilated,  keep  up  the  general 
health  with  nourishing  food,  stimulants,  tonics,  etc.  Early  cau- 
terization should  be  employed  with  the  hot  iron,  nitric,  sul- 
phuric or  muriatic  acid.  All  sloughs  should  be  carefully 
removed.  The  gangrenous  point  should  be  swabbed  with  a 
solution  of  permanganate  or  chlorate  of  potash,  carbolic  acid  or 
chlorinated  lime.  Druitt  strongly  advocates  minute  doses  of 
chlorate  of  potassium.  The  interior  of  the  cheek  may  be 
smeared  with  an  ointment  of  vaseline  and  iodoform,  or  oil  of 
eucalyptus.  If  the  child  cannot  swallow  he  must  be  fed 
through  a  flexible  catheter  introduced  into  the  stomach  through 
a  nostril  or  by  nutrient  enema. 

Acute  Pharyngitis. 

What  is  the  definition? 

An  acute  inflammation  of  the  mucous  membrane  covering 
the  tonsils,  pharynx,  and  soft  palate.  It  may  be  primary  or 
secondary. 

What  are  the  causes? 

The  cause  of  the  primar}'  form  is  usually  due  to  exposure  of 
cold,  impaired  health,  insufficient  clothing,  bad  food,  etc.  The 
disease  is  not  contagious. 

The  secondary  form  accompanies  the  eruptive  fevers,  bron- 
chitis, and  pneumonia. 

What  are  the  symptoms? 

Fever,  thirst,  loss  of  appetite.  The  temperature  may  rise 
to  102°  or  104°  F. ;  the  pulse  runs  from  130  to  140  beats  to 
the  minute  ;  the  throat  is  dry  and  voice  husky,  accompanied 
by  pain  on  swallowing.  On  examination  the  tonsils,  uvula, 
and  pharynx  are  found  to  be  red,  and  may  be  partially  covered 
with  a  whitish  mucus.     The  lymphatic  glands  at  the  angles  of 


38  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

the  jaw  are  slightly  enlarged  and  tender ;  the  breath  is  foul, 
and  the  tongue  heavily  coated  with  a  white  fur. 

What  is  the  diagnosis? 

Inspection  reveals  the  presence  of  inflammation.  Care 
should  be  taken  not  to  confound  the  patches  of  mucus  with 
diphtheritic  membrane.     The  former  can  be  easily  wiped  away. 

What  is  the  treatment  ? 

Mild  cases  require  little  treatment.  By  the  use  of  cam- 
phorated oil,  externally,  and  a  laxative  the  inflammation  soon 
subsides.  Tincture  of  aconite  may  be  given  for  the  fever,  or 
the  solution  of  the  citrate  of  potassium  ;  after  the  fever  has 
subsided  the  following  may  be  used  : — 

IJ:.     Tr.  Ferri  Clilor.   TTj^xxiv. 
Potass.  Chloral,  gr.  xxiv. 
Sjr.  Zingiber  f^j. 
Aquae  q.  s.  ad  f'^iij. — M. 
Sig.  Teaspoonful  every  two  liours  for  a  child  of  two  years. 

Tiie  throat  should  be  wrapped  with  flannel,  moistened 
with  equal  parts  of  turpentine  and  olive  oil,  and  may  be  painted 
with  a  weak  solution  of  nitrate  of  silver  (gr.  v  to  foj)*  if  the 
child  be  old  enough  it  is  well  to  let  him  gargle  his  throat  with 
a  weak  solution  of  the  chlorate  of  potassium  (x-xv  gr.  to  f  ij). 
The  diet  should  consist  of  milk  for  the  first  day,  and  after  the 
fever  subsides  animal  broths,  such  as  beef  tea,  mutton  or 
chicken  broth.  When  convalescence  begins  a  stronger  diet 
may  be  allowed  and  a  suitable  tonic  ,  administered,  such  as 
Huxham's  tincture,  elixir  of  calisaya,  and  tincture  of  nux 
vomica. 

Acute  Tonsillitis. 

What  is  the  definition? 

An  acute  inflammation  of  the  tonsils,  not  of  frequent  occur- 
rence in  infancy,  rarely  occurring  before  the  age  of  five  years. 


DISEASES    OF    THE    MOUTH    AND    THROAT.  39 

What  are  the  symptoms? 

First,  those  of  a  cold  with  rigors,  fever,  flushed  face,  husky 
voice ;  the  child  complains  of  headache,  pain  on  swallowing ; 
the  temperature  rises  quickly  to  100°  or  even  103°  F. ;  the 
tongue  is  furred,  the  tonsils  are  swollen  and  red,  and  may 
be  covered  with  small,  yellow  patches,  resembling  diphtheritic 
membrane ;  the  uvula  and  pharynx  are  generally  swollen,  and 
often  (Edematous,  difficulty  of  swallowing  increases,  and  there 
is  expectoration  of  thick  mucus  ;  pain  is  complained  of  along 
the  course  of  the  Eustachian  tube  to  the  ear  during  the  act  of 
swallowing.  The  inflammation  in  children  usually  terminates 
in  resolution  or  hypertrophy  of  the  tonsils,  rather  than  in 
actual  suppuration  as  in  adults. 

What  is  the  diagnosis? 

Acute  tonsillitis  is  most  likely  to  be  mistaken  for  diphtheria 
and  scarlatinous  angina.  From  the  "former  it  may  be  told  by 
the  more  acute  and  sthenic  character  of  the  symptoms  ;  by  the 
slightness  of  the  swelling  of  the  glands  at  the  angles  of  the  jaw, 
and  by  the  absence  of  pseudo-membranous  exudation.  From 
the  latter  it  may  be  distinguished  by  the  lower  temperature,  less 
frequent  pulse,  and  the  absence  of  the  eruption. 

What  is  the  treatment? 

It  is  often  possible  to  abort  an  attack  by  painting  the  tonsils 
with  a  strong:  solution  of  nitrate  of  silver  and  administering-  a 
brisk  purgative.  If  the  child  is  able  to  swallow,  quinine  should 
be  administered  ;  if  not,  suppositories  of  the  same  should  be 
used.  The  fever  may  be  diminished  with  the  tincture  of 
aconite  in  drop  doses.  The  throat  should  be  treated  with  one 
of  the  following  prescriptions  : — 

^.     Potass.  Chlorat.  gr.  xxiv. 
Tr.  Ferri  Chlor.   nxxxiv. 
Syr.  Zingiber,   f  ^j. 
Aquae  q.  s.  ad  f  ^iij. — M. 
Sig.  Toasijooiiful  every  two  hours  lor  a  child  of  two  years. 


40  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

If  the  cliild  be  old  enough  to  allow  local  applications  to  the 
tonsils,  the  following  will  be  found  very  useful : — 

I^.     Tr.  Ferri  Chlor.  f5iss. 
Glycerinse  f^j. — M. 
Sig.  Use  locally  every  two  or  three  hours. 

Or, 

R.     Argent.  Nitrat.  gr.  v. 
Aqnse  Rosse  f^]. — M. 
Sig.  Touch  tonsils  once  or  twice  daily. 

A  gargle  of  chlorate  of  potassium  may  be  used  with  advan- 
tage, provided  the  child  is  able  to  perform  the  act  properly. 
Flaxseed  poultices  must  be  applied  to  the  neck  to  encourage 
suppuration  ;  the  bowels  should  be  kept  open.  When  the 
abscess  has  broken,  the  mouth  should  be  frequently  washed 
witli  some  weak  antiseptic  solution  ;  the  general  health  of  the 
patient  should  be  carefully  looked  after ;  the  diet  consisting  of 
milk  guarded  with  limewater,  animal  broths  free  from  fat,  and 
stimulants. 

Hypertrophy  of  the  Tonsils. 

Describe  this  disease. 

It  is  slow  in  its  development.  The  disease  is  rarely  recog- 
nized before  the  third  or  fourth  year,  although  its  commence- 
ment in  early  infancy  is  quite  possible. 

What  are  the  causes? 

Constant  attacks  of  tonsillitis,  and  the  irritation  attending 
dentition. 

What  are  the  symptoms? 

Loud  snoring  during  sleep,  a  thick  voice,  and  constant 
snuffling.  On  inspection  the  tonsils  are  found  to  be  very  much 
enlarged  and  project.  The  mucous  membrane  covering  them 
is  usually  pale.     The  follicular  orifices  are  found  to  be  open 


DISEASES    OF    THE    MOUTH    AND    THROAT.  41 

and  very  distinct,  and  may  show  the  yellowish-white  points  of 
retained  secretion.  In  some  cases  the  glands  are  so  large  tijat 
they  meet  and  obstruct  the  throat,  causing  a  constant  hacking 
cough  with  labored  breathing,  difRculty  of  hearing  due  to 
pressure  upon  the  orifices  of  the  Eustachian  tubes. 

What  is  the  treatment? 

Moderate  enlargerlient  will  usually  disappear  when  puberty 
is  passed.  The  syrup  of  the  iodide  of  iron  must  be  employed 
in  combination  with  cod-liver  oil ;  the  tonsils  should  be  painted 
once  daily  with  one  of  the  following  lotions : — 


^.     Tr.  Ferri  Chlor.  f  5j. 
Glycerinse  f^ss. — M. 


Sig. 


R.     Ammon.  lodid.  gr.  x-53S. 
Glycerinse  f§j. — M. 
Sig.  Apply  every  night  with  brush.     (  Waring.} 

;^.     Liq.  Ferri  Perchlorid.  f  3^s-5j. 
Gljceringe  f^j. — M. 
Sig.  Paint  over  tonsils  once  or  twice  daily.     {Mackenzie.) 

T^.     Liq.  Iodine  Comp.  f  5ij" 

Glycerinse  q.  s.  ad  f  ^j. — M, 
Sig.  Paint  once  daily.     {Starr.) 

In  marked  hypertrophy  Dr.  Starr  employs  with  good  results 
the  solid  nitrate  of  silver  every  other  day.  In  making  this 
application  the  caustic  should  be  pointed  and  passed  into  the 
follicles  of  each  gland,  and  then  applied  over  the  whole  mucous 
surface.  Should  the  above  method  fail  excision  must  be 
resorted  to. 

Retro-pharyngeal  Abscess. 

What  is  the  definition? 

A  collection  of  pus  formed  in  the  cellular  tissue  between  the 
posterior  wall  of  the  pharynx  and  the  vertebral  column. 


42  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  are  the  causes  ? 

Direct  injury ;  disease  of  the  cervical  vertebrae ;  severe 
chilling  of  the  body ;  scarlatina,  and  it  very  frequently  arises 
idiopathically. 

What  are  the  symptoms? 

Difficulty  of  swallowing  and  breathing  ;  stiffness  of  the  neck  ; 
difficult  articulation.  The  dyspncea  is  often  alarming  when 
the  patient  is  lying  down,  which  is  readily  eased  by  rising  to 
a  sitting  posture.  On  inspection  the  swelling  can  usually  be 
seen  occupying  the  middle  of  the  pharynx  pressing  forward  the 
uvula  and  soft  palate. 

What  is  the  diagnosis  ? 

The  presence  of  the  tumor  at  the  back  part  of  the  throat, 
difficulty  of  breathing  and  swallowing,  stiflfhess  of  the  neck 
and  fulness  at  the  angles  of  the  jaw. 

What  is  the  prognosis  ? 

Usually  favorable  if  early  recognized  and  not  complicated 
with  cervical  caries. 

What  is  the  treatment  ? 

When  the  seat  of  the  abscess  is  high  up  it  should  be  opened 
with  a  bistoury,  the  blade  being  guarded  with  adhesive  plaster 
allowing  only  an  eighth  or  quarter  of  an  inch  of  the  point  to 
protrude.  If  the  abscess  is  low  down  it  is  safer  to  use  a 
trocar  and  canula.  Light  pressure  must  be  made  on  the  tumor 
with  the  jBnger  for  a  few  days  to  aid  the  evacuation  of  the  pus. 
The  general  health  should  be  maintained  by  suitable  tonics  and 
nutritious  food. 


DISEASES    OF    THE    STOMACH    AND   INTESTINES.  43 

PART   III. 

Diseases  of  the  Stomach  and  Intestines. 

Acute  Gastric  Catarrh. 

What  is  the  definition  ? 

An  acute  catarrhal  inflammation  of  the  mucous  membrane 
of  the  stomach  rarely  seen  in  breast-fed  infants. 

What  are  the  causes  ? 

Dentition,  exposure,  badly  ventilated  houses,  improper  or 
too  much  food,  and  general  feebleness  of  constitution.  It  may 
also  follow  the  administration  of  certain  drugs  in  emetic  doses, 
as  antimony,  ipecacuanha  and  sulphate  of  copper. 

What  are  the  symptoms  ? 

The  attack  comes  on  in  infants  usually  after  a  change  of  diet. 
In  older  children  after  an  indigestible  meal.  The  child  has  a 
hot  dry  skin,  loss  of  appetite,  sleeplessness,  great  thirst,  if  old 
enough  complains  of  headache  and  a  slight  pain  in  the  abdomi- 
nal region.  These  symptoms  are  followed  by  vomiting  of 
curdled  milk  or  whatever  food  remaining  in  the  stomach  that 
is  imperfectly  digested.  Should  repeated  emesis  occur,  as  it 
frequently  does,  there  may  be  painful  retching  and  a  little  bile 
stained  mucus  expelled  ;  the  breath  has  a  disagreeable,  sour 
odor.  The  tongue  is  heavily  coated  with  a  yellowish-white 
fur;  there  is  fever  ranging  from  100°  to  102°  F.,  and  the 
pulse  beats  from  110  to  120  to  the  minute.  There  may  be 
tenderness  on  pressure  in  the  epigastric  region,  and  the  bowels 
are  usually  confined.  These  symptoms  may  continue  from  one 
to  two  days. 

The  attack  may  suddenly  terminate  with  several  loose  stools, 
the  fever  gradually  subsiding,  the  tongue  clearing  and  the 
appetite  retur'^ing. 


44  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  diagnosis  ? 

The  history  of  the  causation,  the  general  character  and  odor 
of  the  vomit,  the  condition  of  the  tongue,  slight  fever,  course 
of  the  attack,  and  epigastric  tenderness. 

What  is  the  treatment  ? 

The  child  should  be  kept  perfectly  quiet.  Relieve  thirst  by 
administering  small  pieces  of  cracked  ice.  Do  not  give  any 
food  until  the  stomach  is  settled.  Should  the  vomiting  be 
obstinate,  apply  a  weak  mustard  plaster  to  the  epigastrium  just 
long  enough  to  redden  the  skin,  and  give  iced  limewater  every 
ten  or  fifteen  minutes  or  the  following  mixture : — 

^.     Liq.  Calcis, 

Aquse  Cinnamomi  aa  f  §iss. — M. 
Sig.  One  or  two  teaspoonfuls,  according  to  the  age,  every  15  or  20 
minutes,  as  necessary.     (Starr.) 

The  subcarbonate  of  bismuth  may  be  used  either  in  powders 
or  in  mixture  with  a  few  drops  of  brandy. 

In  exceptional  cases  in  older  children  where  there  is  headache, 
fever,  abdominal  pain,  and  nausea  without  vomiting,  emesis 
should  be  induced  by  draughts  of  warm  water  or  the  syrup  of 
ipecacuanha.  When  vomiting  has  entirely  disappeared  food 
must  be  given,  at  first,  in  very  small  quantities,  that  is,  not 
more  than  one  ounce  of  milk  with  a  half  ounce  of  lime  or 
barley  water.  After  the  stomach  is  able  to  tolerate  this,  weak 
broths  may  be  given.  The  bowels  should  be  freely  opened  by 
a  mercurial,  followed  by  a  saline  laxative.  The  diet  should  be 
watched  carefully  for  three  or  four  days,  and  pepsin  and  bi- 
carbonate of  soda  powders  administered  after  each  meal. 

Chronic  Gastric  Catarrh. 

What  is  the  definition  ? 

A  chronic  catarrhal  inflammation  of  the  stomach  occurring 
between  the  third  and  seventh  month.  Breast-fed  infants  are 
rarely  affected. 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  45 

What  are  the  causes  ? 

Unsuitable  food,  over-crowding,  filth,  too  early  weaning,  in- 
sufficient clothing,  bad  ventilation,  unclean  milk-cans,  foul 
nursing-bottles  and  rubber  tips,  allowing  the  infant  to  eat  ordi- 
nary table  food. 

What  are  the  symptoms  ? 

Vomiting  of  curdled  milk  stained  by  bile,  occurring  at  irreg- 
ular intervals.  The  character  of  the  vomit  soon  chang-es  and 
a  clear  watery  fluid  with  fragments  of  food  is  ejected.  There 
may  be  eructations  of  sour  fetid  gas.  The  temperature  is  normal, 
the  skin  is  harsh,  and  the  trunk  and  arms  may  be  covered  with 
an  eruption  of  strophulus.  The  lips  are  red  and  dry,  and 
the  tongue  is  coated  with  a  heavy  fur.  The  mouth  is  dry,  and 
the  thirst  is  increased.  The  bowels  are  constipated,  and  the 
evacuations  are  accompanied  by  great  straining  consistkig  of 
small  hard  lumps,  occasionally  covered  with  mucus.  At 
times  moderate  diarrhoea  is  present.  The  abdomen  is  dis- 
tended and  tender,  the  child  loses  flesh,  the  anterior  fontanelle 
becomes  sunken,  the  face  is  pinched,  and  the  eyes  sunken. 
The  child  may  remain  in  this  condition  for  several  months  with 
periods  of  slight  improvement.  The  vomiting  now  becomes 
more  constant,  the  milk  instead  of  being  curdled  is  in  the  same 
state  as  swallowed.  The  body  wastes  rapidly,  and  the  skin 
hangs  in  loose  folds  about  the  limbs.  The  child  is  fretful  and 
the  abdomen  becomes  retracted.  The  pulse  becomes  weak  and 
frequent,  and  the  temperature  falls  below  normal.  The  breath 
iias  a  sour  odor,  the  saliva,  perspiration,  and  urine  are  acid  in 
reaction.  The  patient  lies  utterly  exhausted  in  a  half  con- 
scious condition. 

What  is  the  diagnosis? 

The  long  course  of  the  disease,  the  obstinate  vomiting  of 
sour  liquid,  and  the  emaciated  condition  of  the  body. 


46  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  prognosis? 

Very  unfavorable  under  the  best  circurastances.  The  attack 
may  last  from  two  to  six  months. 

What  is  the  treatment  ? 

The  first  step  is  a  careful  regulation  of  the  diet.  Milk 
should  be  given  cold  guarded  with  lime  or  barley  water  in  tea- 
spoonful  doses  to  be  gradually  increased  as  the  stomach  becomes 
more  retentive.  If  the  child  has  been  weaned  it  is  well  to  try 
a  return  to  the  breast. 

The  clothing  and  hygiene  should  next  be  attended  to.  Tlie 
patient  should  wear  a  flannel  binder,  and  woollen  garments 
next  to  the  skin,  extra  heavy  worsted  stockings  should  be  worn 
to  keep  the  feet  warm.  The  child  must  be  kept  in  a  room  of 
a  temperature  of  68°  or  70°  F.,  and  napkins  or  bedclothing 
containing  vomited  matter  should  be  immediately  removed. 
A  spice  plaster  or  hot  flaxseed  poultice  should  be  worn  over 
the  abdomen  to  relieve  pain,  or  the  part  may  be  rubbed  with 
turpentine  and  olive  oil,  and  if  the  feet  become  cold  they 
should  be  well  rubbed  with  tlie  latter  and  hot  bottles  kept  in 
contact  with  them.  At  the  beginning,  should  the  child's 
strength  warrant  it,  an  emetic  of  ipecacuanha  should  be  given  to 
clear  the  stomach  of  its  acid  contents.  To  check  the  vomiting 
Fowler's  solution  (Liq.  Potass,  arsenit.),  should  be  administered 
one-half  drop  three  times  a  day  for  a  child  three  months  old. 
Should  this  fail,  the  wine  of  ipecacuanha,  one  drop  every  tw'o 
or  three  hours,  or  the  tincture  of  nux  vomica  in  half  drop 
doses  may  be  given  three  times  a  day,  or  minute  doses  of 
calomel. 

For  the  prostration  stimulants  must  be  given.  Whiskey 
should  be  administered  every  two  or  three  hours  in  ten  or 
fifteen  drop  doses. 

During  convalescence  bitter  tonics  may  be  employed,  such  as 
tincture  of  nux  vomica,  elixir  of  calisaya,  etc. 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  47 


Ulcer  of  the  Stomach. 

What  is  the  definition? 

An  ulcer  involving  the  mucous  membrane  of  the  stomach, 
occasionally  occurring  in  new-born  infants,  but  rarely  seen 
afterward.  It  may  occur  either  as  a  single  ulcer,  with  a 
tendency  to  perforation  as  in  adults,  or  as  small  erosions  which 
cover  the  surface  of  the  mucous  membrane  and  assume  the 
appearance  of  lacerated  follicles. 

What  are  the  causes  ? 

In  older  cliildren  the  same  as  in  adults,  namely,  privation, 
fatigue,  disease  of  the  lung,  heart,  kidneys  or  liver  and  tlie 
irritation  of  food.  In  new-born  infants  the  circulatory  dis- 
turbances which  ensue  somewhat  suddenly  at  birth,  the  sudden 
arrest  of  the  placental  stream,  the  slow  development  of  the 
pulmonary  circulation,  often  associated  with  partial  atelectasis 
which  predisposes  to  venous  congestion  in  the  abdominal 
viscera  and  gives  much  ground  to  the  belief  that  congestion 
and  probably  ecchymosis  are  at  the  root  of  the  ulceration. 

What  are  the  symptoms? 

Vomiting  of  blood  is  the  most  important  symptom.  Should 
a  healthy  child  vomit  blood  within  a  few  hours  after  birth  it 
may  have  a  gastric  ulcer.  In  older  children  the  symptoms  are 
the  same  as  in  adults — pain  in  the  epigastrium,  vomitinor,  etc. 

What  is  the  treatment  ? 

In  infants  the  bleeding  often  proves  fatal  before  any  treat- 
ment is  available.  The  child  may  be  given  cold  alum  whey 
and  some  castor  oil,  which  by  opening  the  bowels  may  relieve 
any  local  plethora  that  might  be  present. 

In  older  children  the  treatment  is  the  same  as  for  adults, 
and  the  reader  is  referred  to  works  on  general  practice. 


48  ESSENTIALS    OF    DISEASES    OP    CHILDREN. 

Vomiting. 

How  may  vomitings  be  divided? 

Into  three  classes,  namely,  the  vomiting  of  nurslings,  the 
vomiting  of  older  children,  and  reflex  vomiting. 

Describe  the  vomiting  of  nurslings. 

It  is  perfectly  physiological,  showing  that  the  stomach  is 
full.  It  usually  occurs  immediately  after  nursing,  and  the 
milk  is  unchanged.  Should  it  continue,  however,  the  little 
patient  must  be  carefully  watched,  as  it  may  become  increas- 
ingly frequent,  the  vomit  being  more  copious  and  the  intervals 
of  ejection  shorter,  till  finally  no  food  is  retained. 

What  is  the  treatment? 

If  it  be  due  to  undigested  food  an  emetic  should  be  given, 
consisting  of  a  teaspoonful  of  the  wine  of  ipecacuanha ;  the 
bowels  should  be  opened  by  the  use  of  calomel  (gr.  l),  or 
castor  oil,  one  teaspoonful ;  a  mixture  of  equal  parts  lime 
and  cinnamon  water  may  be  used  ;  bismuth,  bicarbonate  of 
sodium,  calomel,  etc.,  will  be  found  useful.  The  diet  should 
be  carefully  looked  into,  as  this  trouble  is  usually  found  in 
artificially-fed  infants. 

Describe  the  vomiting  in  older  children. 

This  is  usually  due  to  indigestion.  Sudden  vomiting  in  a 
child  of  previous  good  health  should  suggest  the  possibility  of 
an  onset  of  some  acute  disease — as  scarlet  fever. 

Describe  reflex  vomiting. 

It  may  be  due  to  meningitis,  tumor  of  the  brain,  pertussis, 

chronic  lung  disease,  dentition,  and  worms. 

Describe  the  vomiting  of  brain  disease. 

It  is  erratic  in  its  occurrence.  The  tongue  is  perfectly 
clean,  and  there  are  no  gastro-intestinal  symptoms  ;  the  usual 
evidences  of  cerebral  disease  are  present — such  as  headache, 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  49 

impaired  muscular  power,  diminished  acuteness  of  vision,  and 
intermittent  action  of  the  pulse. 

What  is  the  treatment? 

Same  as  for  simple  vomiting,  and  treating  symptoms  as  they 
arise. 

Flatulence  and  Colic. 

Describe  these  disorders. 

They  are  among  the  most  frequent  digestive  troubles  in 
infancy. 

What  are  the  symptoms? 

Soon  after  food  is  taken  the  child  becomes  restless,  kicks  its 
legs  about  and  cries  ;  the  stomach  is  rigid,  the  face  pale,  and 
the  vomiting  of  curds  may  occur.  As  the  meal  is  digested 
the  pain  ceases. 

What  is  the  treatment? 

Should.it  be  due  to  indigestible  food,  the  milk  must  be 
diluted  with  an  alkali — such  as  limewater,  or  bicarbonate  of 
sodium,  or  by  the  addition  of  properly-made  barley  water.  Of 
the  drugs,  any  of  the  aromatic  waters  may  be  employed.  Soda 
mint  in  hot  water  is  usually  successful  in  relieving  the  flatu- 
lence. When  the  pain  is  very  severe  twenty  or  more  drops  of 
brandy  may  be  given  in  hot  water,  and  a  linseed  meal  poultice 
applied  to  the  abdomen.  If  the  bowels  are  confined  a  tea- 
spoonful  of  castor  oil  should  be  administered. 

Constipation. 

How  may  constipation  be  divided? 

Into  two  classes,  namely,  constipation  of  infancy,  and  con- 
stipation in  older  children. 

What  are  the  causes  of  the  former  class  ? 

Feebleness  in  the  muscular  expulsive  power  of  the  intestines, 
4 


50  ESSENTIALS    OF    DISEASES    OF    CHILDREN, 

in  the  material  it  contains,  or  both  ;  malformations  about  the 
anus — as  fissure.  It  is  more  frequent  among  hand-fed  babies 
than  those  nursed  at  the  breast.  It  is  commonly  due  to  the 
use  of  cows'  milk  containing  a  large  percentage  of  casein, 
starchy  foods,  etc. 

What  is  the  treatment? 

If  the  child  be  nursed  at  the  breast  it  may  be  treated  through 
the  mother's  milk  ;  but  this  plan  is  rarely  satisfactory.  For 
the  child  castor  oil  is  an  old-time  remedy,  and  really  quite 
efficient  for  temporary  constipation.  Should  the  constipation 
become  chronic  small  doses  of  fluid  magnesia  may  be  given 
three  or  four  times  daily,  or  sulphate  of  magnesium  in  five 
grain  doses,  the  bitter  taste  being  properly  disguised  in  a 
suitable  syrup.  Manna  is  a  useful  drug,  and  is  best  adminis- 
tered by  dissolving  a  bit  the  size  of  a  pea  in  the  nursing-bottle, 
or  it  may  be  given  in  the  following  way  : — 

I^.     Mannse  Opt.  5.1' 
Syr.  Simp,  f  ^=s. 
Aquae  Cinnam.  q.  s.  ad  f  ^j* 
Sig.  Teaspoonful  three  times  a  day. 

Or, 

I^.     Tr.  Aloes  et  Myrrh  ^j. 
Sig.  One  to  three  drops  in  sweetened  water  two  or  three  times  daily, 
according  to  age. 

Or, 

^.     Mannae  Opt., 

Magnessii  Garb,  aa  5j' 
Ex.  Sennse  fl.  f  Siij* 
Syr.  Zingiberis  f§j. 
Aquae  q.  s.  ad  f  ^iij. 
Sig.  One  or  two  teaspoonfuls  three  times  a  day  for  a  child  of  two 
years.     {Goodhart  and  Starr.) 

The  diet  should  be  carefully  regulated,  and  the  lower  bowel 
be  encouraged  to  expel  its  contents  by  enema,  or  suppository 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  51 

of  soap  or  glycerine.  Oat-meal  water  may  be  used  to^  dilute 
the  milk  instead  of  the  plain  at  least  twice  during  the  day,  and 
friction  should  be  applied  to  the  abdomen  night  and  morning, 
rubbing  in  a  teaspoonful  of  warm  olive  oil. 

An  enema  may  be  given  every  morning,  or  even  twice  a  day 
if  necessary,  consisting  of  soap  and  water.  Glycerine  ei.ema 
is  highly  recommended,  one-half  teaspoonful  with  two  tea- 
spoonfuls  of  water  should  be  given  to  a  child  of  six  months. 

At  times  the  constipation  is  associated  with  much  flatulence 
and  pain,  then  a  teaspoonful  of  fluid  magnesia  may  be  admin- 
istered with  a  little  sweet  spirits  of  nitre  and  sulphate  of  mag- 
nesium. If  associated  with  heartburn,  which  causes  the  child 
to  cry  with  pain  or  make  faces  and  have  hiccoughs,  the  follow- 
ing is  used  by  Dr.  Eustace  Smith  : — 

5.     Sodii  Bicarb.  5)' 

Tr.  Nucis  Vomicse  "nx^j' 
Tr.  Cardamomi  Comp., 
Syr.  Simp,  aa  f  5ij' 
Aquse  Chloroform  (Br.  P.)  f  §3S. 
Aquse  q.  s.  ad  f  ^ij. 
Sig.  One  teaspoonful  every  six  hours. 

Aloes  powdered  and  dissolved  in  milk  is  recommended,  also 
drop  doses  of  fluid  extract  of  cascara  sagrada  or  tincture  of 
podophyllin. 

What  are  the  causes  of  constipation  in  older  children? 

Indigestion,  improper  food,  diseases  of  the  stomach  and 
liver,  syphilis,  malaria,  etc.  More  common  in  girls  than  in 
boys. 

What  are  the  symptoms  ? 

The  little  patients  are  found  to  be  rather  fretful  without  any 
definite  symptoms  of  disease ;  their  appetites  are  capricious, 
the  breath  generally  very  offlensive.  The  abdomen  is  large 
and  tumid,  the  distention  being  marked. 


52  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  treatment  ? 

Regular  habits  must  be  insisted  upon.  The  child  should  be 
taken  to  the  closet  a  certain  hour  each  day.  The  juice  of  an 
orange  or  an  alkaline  water  must  be  given  before  breakfast, 
or  stewed  prunes,  and  figs,  as  a  dessert.  Should  these  simple 
remedies  fail  to  relieve  the  trouble,  one  of  the  following  pre- 
scriptions will  be  found  useful : — 

R.     Ex.  Belladonnae  gr.  A. 

Pil.  Aloes  et  Myrrh,  gr.  ix. 

01.  Carl  gtt.  ij. 
M.  et  ft.  pil.  No.  vi. 
Sig.  One  pill  at  bedtime  for  a  child  of  six  years.  (  Goodhart  and  Slarr.') 

R.     Ex.  Cascarge  Sagrad.  Fl.  f  ^j. 
Sig.  Three  drops  three  times  a  day,  to  be  increased  as  necessary  for 
a  child  of  five  years. 

R.     Pulv.  Glycyrrhizse  Comp.  §j. 
Sig.  Cofl"eespoonful  at  bedtime  for  a  child  of  six  or  seven. 

R.     Tr.  Aloes  et  Myrrh,  f  5iij' 
Syr.  Zingiber,  f  ^ss. 
A  quae  q.  s.  ad  f  ^ij. — M. 
Sig.  Teaspoonful  two  or  three  times  daily  for  a  child  of  six  years. 

R.     Ex.  Belladonnse  gr.  j. 
Grlycerinse  f^j. 

Vini  Ferri  Amar.  q.  s.  ad  f  §iij. — M. 
Sig.  Teaspoonful  three  times  a  day  at  the  age  of  six  years. 

(^Goodhart  and  Starr.) 

Cheadle's  formula  of  twenty  to  forty  grains  each  of  the  sul- 
phate of  soda  and  sulphate  of  magnesia  is  highly  indorsed. 

Constipation  associated  with  sickness  sliould  always  be  care- 
fully investigated,  and  the  possible  existence  of  intussusception, 
peritonitis,  and  brain  disease  should  be  remembered. 

When  constipation  is  obstinate  from  birth,  the  rectum  should 
be  carefully  examined.  Constipation  in  young  children  is  not 
unfrequently  associated  with    small  fissures   about   the  anus, 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  53 

causing  severe  pain  during  tlie  act  of  defecation,  and  in  some 
cases  the  pain  is  so  intense  that  the  sphincter  contracts  tightly 
and  prevents  any  expulsive  etFort.  The  treatment  in  such 
cases  would  be  to  keep  the  bowels  slightly  relaxed,  to  prevent 
any  stretching  of  the  parts,  to  keep  the  fissure  and  lower  inch 
of  the  rectum  well  anointed  with  the  following  ointment : — 

^.     Ungt.  Plumbi  Carbonat.  5J« 
Uiigt.  Hydrarg., 
Ungt.  Zinci  Oxidi  aa  5ij- — M« 
Sig.  Apply  two  or  three  times  a  day. 

If  a  dry  dressing  is  preferred,  equal  parts  of  lycopodium  and 
calomel,  or  oxide  of  zinc  and  calomel  may  be  dusted  over  the 
part. 

In  some  cases  it  may  be  necessary  to  paint  it  with  nitrate 
of  silver,  or  even  stretch  it  forcibly  with  the  fingers,  which  is 
usually  successful. 

Simple  Diarrhoea. 

What  are  the  synonyms  ? 

Muco-enteritis,  catarrhal  enteritis. 

What  is  the  definition? 

Frequent  evacuations  from  the  bowels  of  a  thin  watery 
character  without  tenesmus. 

What  are  the  causes  ? 

Unfavorable  hygienic  conditions,  impure  milk,  summer  heat 
in  a  crowded  city,  dentition,  improper  food,  and  overfeeding. 

What  are  the  symptoms  ? 

The  onset  may  come  on  with  vomiting  and  purging  or  with 
apparently  little  disturbance  of  the  general  health.  Tliere  is 
pallor,  slight  fretfulness,  restlessness,  and  usually  a  rise  in 
temperature.  The  mouth  is  generally  dry  and  the  child  thirsty  ; 
the  tongue  will  be  found  much  redder  than  natural,  and  the 


54  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

papillae  prominent.  The  motions  are  of  a  liquid  consistency, 
and  usually  green  or  a  yellowish  color  with  a  very  offensive 
odor. 

What  is  the  treatment? 

Careful  attention  should  be  given  to  the  diet,  and  at  the 
beginning  of  an  attack  it  is  well  to  use  a  gentle  laxative  as 
castor-oil  to  clear  out  the  intestinal  canal  before  the  adminis- 
tration of  astringents,  then  one  of  the  following  prescriptions 
will  be  found  useful : — 

^.     Bismuth  Subcarb.  5ss-5iss. 
Spt.  Mjristicse  ll\,xx. 
Spt.  Vini  Gal.   f5iss  5h*j. 
Syr.  Acacise  f  ^iss. 
Aquae  Cmnam.  q.  s.  ad  f  fiij. — M. 
Sig.  (Shake  well.)     Teaspoonful  every  two  hours. 

Or, 

1^.     Magnesise  Sulphat.  5j' 

Tr.  Opii  Deed  oral.  gtt.  xij. 
Syr.  Simp.   f^ss. 

Aquae  Ciiinam.  q.  s.  ad  f  ^iss. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  one  or  two  years. 

(Meigs  and  Pepper.) 

Or, 

5.     Tr.  Opii  Deod.  lT|.vj. 

Bismuth  Subcarb.  gr.  Ixxij. 

Syr.  Acacise  f  ^ss. 

Mist.  Cretse  q.  s.  ad  f  ^iij- — M. 
Sig.  Teaspoonful  every  two  hours. 

Should  the  stools  remain  green  and  slimy  a  course  of  minute 
doses  of  calomel  will  be  useful. 

^..     Hydrarg.  Chlor.  Mit.  gr.  j. 

Saccli.  Lact.  gr.  xij. 

Pulv.  Aromat.  gr.  vj. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  every  two  hours. 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  55 


Entero-colitis. 

What  are  the  synonyms? 

Febrile  diarrlioea,  summer  diarrhcEa,  *'  summer  complaint," 

inflammatory  diarrhoea. 

What  is  the  definition? 

A  catarrhal  inflammation  of  the  lower  portion  of  the  small 
intestines  and  the  upper  portion  of  the  large,  characterized  by 
diarrhcea,  nausea,  vomiting,  pain,  swelling  of  the  abdomen,  and 
emaciation. 

What  are  the  causes  ? 

Residence  in  large  cities,  bad  hygienic  surroundings,  over- 
crowding, decomposing  organic  matter,  high  temperature.  The 
disease  is  very  rare  in  winter ;  usually  begins  about  the  first 
of  June,  and  disappears  in  the  early  part  of  September.  Hand- 
fed  babies  are  more  prone  to  it.  Impure  food,  sour  milk,  fari- 
naceous preparations  in  excess,  over-ripe  fruit,  etc.  It  usually 
occurs  between  the  sixth  and  eighteenth  months  of  life,  after 
the  second  year  the  attacks  are  less  common. 

What  are  the  anatomical  lesions? 

There  is  hyperaemia  of  the  mucous  membrane  of  the  ileum 
and  colon,  probably  more  marked  about  the  ileo-caecal  valve 
and  in  the  sigmoid  flexure.  The  intestinal  glands  are  enlarged, 
and  the  Peyer's  patches  tumid,  elevated,  and  punctured.  The 
peritoneum  over  the  inflamed  glands  is  injected,  and  the  mesen- 
teric glands  are  enlarged.  The  stomach  may  at  times  be 
normal,  or  the  seat  of  catarrh,  the  mucous  membrane  being 
thickened  and  inflamed. 

If  the  disease  assumes  a  chronic  form,  the  glands  break 
down  and  superficial  oval  ulcers  are  formed. 

What  are  the  symptoms  ? 

The  attack  is  generally  preceded  by  disturbed  sleep,  restless- 


56  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

ness,  eructations  of  a  sour-smelling  liquid,  which  in  some  cases 
is  very  offensive,  an  increase  in  the  number  of  stools,  with  a 
decrease  of  their  consistency. 

In  one  or  two  days  diarrhoea  and  vomiting  begin  ;  the  latter 
is  very  obstinate,  and  the  ejections  consisting  of  sour,  undigested 
food. 

Describe  the  stools. 

They  may  average  from  six  to  twenty  or  even  more  in  the 
twenty-four  hours.  They  may  be  semi-solid,  of  a  yellowish 
color,  with  a  fecal  odor ;  or  liquid,  green  in  color,  acid  in 
reaction  ;  or  they  may  contain  quantities  of  mucus  and  blood ; 
or  towards  the  end  be  almost  serous  and  Yerj  offensive. 

What  other  symptoms  shoiild  be  looked  fori 

The  tongue  is  dry  and  coated,  red  at  the  tip  and  edges, 
appetite  poor,  increased  thirst,  and  distention  of  the  abdomen. 
The  skin  is  hot  and  dry.  The  pulse  is  weak  and  may  run  up 
to  120  or  even  140  to  the  minute.  The  urine  is  high  colored, 
scanty,  and  passed  at  long  intervals. 

As  the  disease  progresses  the  face  becomes  pale,  the  eyes 
are  sunken  and  dull,  the  fontanelle  is  depressed,  there  is  great 
emaciation.  The  buttocks  and  inner  surface  of  the  thighs 
become  reddened  from  the  acid  stools  and  concentrated  urine. 

What  is  the  diagnosis  ? 

The  fever,  vomiting,  the  number  and  appearance  of  the 
stools,  the  age  of  the  child,  the  season  of  the  year,  the 
locality  and  general  surroundings  make  the  diagnosis  of 
entero-colitis  quite  easy. 

What  is  the  prognosis  ? 

The  outlook  is  usually  bad,  although  a  large  proportion  of 
cases  recover  under  proper  treatment.  It  is  much  more  fatal 
among  the  children  of  the  poor  who  are  unable  to  have  a 
proper  plan  of  treatment  carried  out.  The  disease  may  prove 
fatal  in  a  few  days. 


DISEA.SES    OF    THE    STOMACH    AND    INTESTINES.  57 

What  is  the  treatment  ? 

First  remove  the  cause.  The  child  should  be  taken  to  the 
country  or  sea-coast  at  once ;  if  this  is  impracticable  it  should 
be  kept  in  public  squares  where  there  is  a  free  circulation  of  air. 
The  heat  of  the  day  must  be  passed  in  some  cool  spot.  The 
child  should  be  allowed  to  lie  in  a  clean  cool  bed  and  not 
fondled  too  much. 

The  clothing  should  be  as  thin  as  possible,  but  it  must  not 
be  forgotten  that  flannel  should  always  be  worn  next  to  the 
skin.  In  the  beginning  of  the  attack  the  body  must  be  care- 
fully sponged  with  water  at  80°  F.,  and  gently  dried.  The 
diet  must  be  carefully  regulated,  the  quantity  as  well  as  the 
quality.  Cracked  ice  may  be  given,  and  where  water  is  used 
it  should  always  be  filtered  or  boiled.  Should  the  child  be 
hand-fed  great  stress  should  be  laid  upon  the  care  of  the  milk, 
the  nursing-bottles  and  tips. 

If  vomiting  occurs  all  food  must  be  discontinued  for  at  least 
twelve  hours,  and  the  thirst  quenched  by  the  use  of  thin  barley 
gruel,  Vichy  water,  etc.,  always  given  cold.  In  bottle-fed 
children  it  is  well  to  stop  the  use  of  milk  entirely  and  give 
chicken  or  mutton  broth  (free  from  fat),  wine  whey,  beef  juice 
(expressed  from  a  rump  steak).  Mellin's  food  with  barley 
gruel  or  raw  scraped  beef. 

The  first  step  in  the  medical  treatment  is*  to  empty  the 
bowels,  and  for  this  purpose  there  is  nothing  better  than  plain 
castor  oil  or  the  following  emulsion  of  the  same  : — 

^.     Emul.  Ricini,  50  %   f§j. 
Sig.  Teaspoon ful  for  a  child  of  one  year. 

Should  the  stomach  reject  this,  an  enema  may  be  substi- 
tuted. This  should  consist  of  water  that  has  been  previously 
boiled  and  when  used  the  temperature  must  be  65°  or  70°  F., 
about  one  pint  for  a  child  of  six  months,  and  double  the 
quantity  for  a  child  of  two  years.  The  injection  is  best  given 
slowly  with  a  fountain  syringe. 


58  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

To  abort  decomposition  and  restore  a  healthy  action  to  the 
intestines,  calomel,  salicylate  of  sodium  or  naphthalin  may  be 
given. 

^.     Hydrarg.  Clilor.  Mil.  gr.  j. 

Bismuth  Subnit.  gr.  xxxvi-3j. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  every  two  hours. 

^.     Sodii  Salicylat.  gr.  xxiv-lxxij. 
Aquae  Clnnam.  f^iij. — M. 
Sig.  Teaspoonful  every  two  hours. 

1^.     Naphthalin  gr.  xii-5j. 

Sacch.  Lact.  gr.  xii-5ss. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  every  three  hours. 

The  bichloride  of  mercury  may  be  given  in  doses  of  yj^  to 
jAq  of  a  grain,  but  it  usually  causes  vomiting  even  in  these 
minute  doses.  The  following  will  be  found  a  very  valuable 
formula. 

^.     Bismuth  Salicylat.  gr.  xxiv-lxxij. 
Syr.  Acacise  f^j. 

Aquae  Cinnam.  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  every  three  hours. 

Counter- irritation  over  the  abdomen  is  useful  either  by  the 
use  of  weak  mustard  or  the  ordinary  spice  plasters. 

Alcohol  should  be  used  when  indicated  to  support  the 
system,  and  during  convalescence  tonics  are  required,  such  as 
the  elixir  of  calisaya,  etc. 

Cholera  Infantum. 

What  is  the  synonym  ? 
"  Summer  complaint." 

What  is  the  definition  ? 

An  acute  catarrhal  inflammation  of  the  mucous  membrane 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  59 

of  the  stomach  and  intestines,  occurring  usually  during  the  first 
dentition ;  characterized  by  severe  vomiting  and  purging, 
colicky  pains,  and  prostration. 

What  are  the  causes  ? 

The  same  as  entero-colitis.  It  may  occur  at  any  age  under 
two  years,  but  is  most  frequent  between  the  sixth  and  the 
twelfth  months. 

What  are  the  anatomical  lesions  ? 

The  gastro-intestinal  mucous  membrane  is  very  much  con- 
gested, thickened  and  softened,  and  the  glands  are  enlarged. 
The  sympathetic  system  is  much  disturbed. 

What  are  the  symptoms  ? 

The  onset  is  always  sudden ;  the  first  symptom  is  the 
appearance  of  large  watery  evacuations  which  are  often  so 
serous  that  they  do  not  stain  the  napkin,  or  they  may  be  of  a 
greenish-yellow  or  a  dirty  brown  fluid.  The  first  mentioned 
are  usually  odorless,  but  the  others  have  an  offensive  smell 
which  is  not  easily  forgotten.  The  number  of  motions  vary 
from  ten  to  thirty  in  the  twenty-four  hours. 

Next,  the  stomach  becomes  irritable,  everything  is  vomited 
immediately  after  being  taken,  and  there  is  severe  retching  ;  the 
appetite  is  lost,  the  thirst  intense,  the  tongue  dry  and  pasty,  the 
abdomen  flabby.  There  is  much  restlessness,  and  the  tempera- 
ture may  reach  105°,  or  even  108°  F. ;  the  pulse  is  weak,  the 
breathing  irregular,  urine  almost  suppressed  ;  in  a  few  hours 
the  face  becomes  pale,  the  eyes  are  dull  and  sunken,  and  the 
lips  parted ;  the  fat  of  the  body  seems  to  melt  away,  the 
muscles  become  flabby,  the  skin  is  dry  and  hangs  in  loose 
folds.  Next,  there  is  rapid  collapse,  cold  breath,  uncountable 
pulse,  irregular  breathing,  suppression  of  urine,  and  at  last 
death. 

The  attack  often  proves  fatal  in  from  twenty-four  to  forty- 
eisht  hours. 


60  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  diagnosis? 

The  character  and  odor  of  the  stools,  the  frequent  vomiting, 
intense  thirst,  high  temperature,  rapid  emaciation,  collapse, 
irregular  breathing,  etc.  This  disease  is  said  to  resemble 
sunstroke. 

What  is  the  prognosis? 

Very  unfavorable.  The  child  should  be  removed  to  the 
country  or  seashore  at  once,  as  this  offers  about  the  only 
chance  for  recovery. 

What  is  the  treatment? 

Owing  to  the  great  strain  upon  the  system  from  frequent 
evacuations  and  vomiting,  food  should  be  given  to  replace  the 
waste. 

The  first  indications  for  medical  treatment  should  be  to 
arrest  the  vomiting  and  purging,  for  which  the  following  may 
be  given : — 

^:.     Bismuth  Subnit.  5ss-3iss. 
Spt.  Myristicse  rr^xx. 
Spt.  Vini  Gal.  f  5iij. 
Syr.  Acaciae  §iss. 
Aquse  Cinnam.  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  every  two  hours. 

If  this  fails,  broken  doses  of  calomel  with  a  few  grains  of 
subnitrate  of  bismuth  will  be  found  useful. 

^.     Hydrarg.  Chlor.  Mit.  gr.  ^. 
Bismuth  Subnit.  gr.  xxxvj. 
M.  et  ft.  chart.  No.  xii.  *• 

Sig.  One  powder  every  hour  or  two. 

Or, 

^.     Liq.  Calcis, 

Aquse  Cinnam.  aa  §j. — M. 
Sig.  Teaspoonful  when  required. 

The   child   should  be   allowed  to  suck  ice  constantly,  and 


DISEASES    OP    THE    STOMACH    AND    INTESTINES.  61 

drink  cool,  filtered  water.     To  check  the  purging  astringents 
and  opium  should  be  used.     Sulphuric  acid  is  often  of  value. 

5"     Acid.  Sulphuric.  Aromat.  nxxxiv. 
Liq.  Morphiae  Sulphat.  t'5j. 
Elix.  Curacoffi  f^i]. 
Aquae  q.  s.  ad  f  §iij. — M. 
Sig.  Teaspoonful  every  three  hours  for  a  child  one  year  old. 

{Goodhart  and  Starr.') 

An  enema  of  two  or  three  drops  of  laudanum  suspended  in 
starch-water  may  be  given  every  third  hour. 

Monti  highly  indorses  intestinal  irrigation  by  means  of 
copious  enemata  of  from  one  to  three  pints  of  warm  or  cool 
water,  allowed  to  flow  from  an  ordinary  fountain  syringe  into 
the  bowel.  Mustard  plasters  should  be  applied  to  the  abdomen 
several  times  in  the  twenty-four  hours,  or  a  spice  plaster,  or 
flax-meal  poultice  constantly  worn,  renewing  every  two  hours. 
The  body  should  be  sponged  night  and  morning  with  tepid 
water.  The  child  must  be  kept  in  a  large  well- ventilated 
room,  and  on  a  cool,  clean  bed,  if  possible,  and  not  held  in  the 
lap ;  the  clothing  and  diapers  should  be  kept  clean,  and  the 
clothes  thoroughly  aired  before  putting  on. 

Stimulants  should  be  given  at  the  start ;  from  five  to  twenty 
drops  of  good  rye  whiskey  should  be  given  every  two  hours  in 
a  little  limewater  or  Vichy. 

In  the  state  of  collapse  the  bodily  temperature  must  be  kept 
up  by  the  use  of  hot  bottles,  flannels,  etc.  In  this  stage  a 
mustard  bath  will  be  found  valuable. 

Chronic  Diarrhcea. 

What  are  the  synonyms? 

Chronic  intestinal  catarrh  ;   chronic  entero-colitis. 

What  are  the  causes? 

Neglect  among  children  of  the  poor,  filth,  series  of  attacks  of 


62  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

simple  diarrhoea,  lack  of  cleanliness.  Usually  occurs  in  infants 
from  six  to  twenty-four  months,  and  frequently  in  older  child- 
ren. In  children  of  the  well-to-do  it  generally  results  from 
improper  feeding. 

What  are  the  symptoms? 

Tlie  stools  at  tirst  may  be  abundant  although  their  character 
is  not  abnormal  ;  then  they  may  gradually  become  pale  in 
color  and  thinner  in  consistency ;  the  child  loses  flesh ;  the 
stools  become  lumpy,  with  at  first  a  small  quantity  of  mucus  ; 
in  the  later  stages  they  are  more  frequent,  and  the  amount  of 
mucus  is  increased ;  their  color  may  be  of  a  dirty  brown  water 
containing  green  particles,  which  is  commonly  known  as  the 
spinach  stool.  The  child  continues  to  waste  rapidly ;  the 
skin  is  dark  and  dry,  hanging  in  folds  upon  the  frame ;  the 
face  is  wrinkled,  and  much  resembles  that  of  an  old  man  ; 
the  cry  is  weak,  the  tongue  red  and  dry,  and  the  abdomen 
usually  distended.  If  the  diarrhoea  is  not  checked,  the  child 
gradually  becomes  more  feeble,  and  sinks  into  a  semi-comatose 
state;  the  temperature  falls  below  normal,  the  extremities  be- 
come cold,  and  the  child  may  succumb  to  exhaustion,  or  pro- 
bably convulsions. 

What  is  the  morbid  anatomy  ? 

The  coats  of  the  stomach  and  intestines  are  atrophied,  pale 
and  thin.  The  mucous  membrane  of  the  lower  part  of  the 
small  intestine  is  covered  with  black  specks  which  are  due  to 
altered  blood  pigment  deposited  round  the  ulceration  of  the 
solitary  glands  and  follicles.  There  may  be  more  or  less  super- 
ficial erosion  of  the  mucous  membrane,  and  the  mesenteric 
glands  are  swollen. 

What  is  the  diagnosis  ? 

Chronic  diarrhoea  is  liable  to  be  mistaken  for  tuberculosis 
of  the  intestines.  If  it  begins  soon  after  birth  and  there  be  a 
history  of  bad  feeding,  exposure,  neglect,  with   no   constant 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  G3 

elevation   of  temperature,   the   affection   is   probably  chronic 
diarrhoea. 

Tuberculous  diarrhoea  usually  occurs  after  the  third  year,  it 
is  attended  by  pyrexia  and  enlarged  mesenteric  glands.  There 
is  tenderness  on  pressure  in  the  right  iliac  fossa,  and  the 
abdominal  wall  is  tense  over  this  region.  The  evacuations  are 
intensely  fetid,  brown  and  liquid  when  voided,  but  if  left 
standing  a  dark  sediment  settles,  composed  of  flocculent  matter 
with  small  clots  of  blood  and  masses  of  mucus  and  pus. 

What  is  the  prognosis  ? 

Grave,  in  children  under  the  age  of  two  years,  and  when  it 

occurs  in  syphilitic,  rachitic,  or  feeble  children. 

What  is  the  treatment  ? 

Tlie  hygienic  surroundings  should  be  carefully  attended  to 
and  the  child  kept  perfectly  clean.  The  diet  should  be  liquid 
and  carefully  regulated.  The  following  prescription  will  be 
found  useful  for  a  child  of  ten  years : — 

^.     Ferri  Sulphat.  gr.  viij. 
Magnesii  Sulphat.  5.1- 
Acid.  Sulphur,  dil.   f  50"- 
Syr.  Zingiber,  f^ss. 
Aquse  Cari  q.  s.  ad  ffiv. — M. 
Sig.  Teaspoonful  in  water  three  times  a  day.     {Goodhart  and  Starr.) 

In  older  children  prolapsus  ani  often  occurs ;  this  should  be 
relieved  by  strapping  the  buttocks  together  or  using  an  enema 
of  sulphate  of  iron  (5j  Oss),  a  third  part  to  be  used  every 
morning. 

Any  of  the  following  prescriptions  will  be  found  useful: — 

]^.     Tr.  Kramerise, 

Tr.  Opii  Camph.  aa  5ij- 
Mist.  Cretae  q.  s.  ad  f  §ij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  two  years. 


64  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

^.     Acid.  Sulphuric,  dil.  f  5J-3iss. 
Liq.  Morphise  Sulphat.  f  5ij-3iiss. 
Spt.  Vini  Gallici  f  3"J-5''''' 
Syr.  Zingiber,  f  gss. 
Aquse  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  three  or  four  times  a  day  for  a  child  of  two  or 
three  years. 

^..     Acid.  Gallici, gr.  x. 
Vini  Opii  v\v. 
Alcohol  f5iss. 

Aquae  Chloroform  q.  s.  ad  f  ^iss. — M. 
Sig.  Teaspoonful  three  times  a  day. 

Nitrate  of  silver  is  valuable  when  the  diarrhoea  is  very 
obstinate  and  if  aphthae  appear  in  the  mouth,  the  following  is 
a  very  useful  formula  : — 

^.     Argenti  Nitratis  gr.  j. 
Syr.  Acacise  §ij. 

Aquse  Cinnam.  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  two  years. 

Stimulants  should  be  given  to  relieve  the  prostration, 
whiskey  being  the  best  in  doses  of  about  ten  drops  every  two 
hours.  Astringent  enemata  may  be  used.  Nitrate  of  silver, 
one  grain  to  five  ounces  of  water  is  highly  recommended  by 
Trousseau,  but  Goodhart  and  Starr  prefer  equal  parts  of  an 
infusion  of  ipecacuanha  and  decoction  of  starch. 

When  improvement  sets  in,  strong  tonics  must  be  employed 
to  build  up  the  strength. 

Dysentery, 

What  are  the  synonyms  ? 

Bloody  flux.     Ulcerative  colitis. 

What  is  the  definition? 

An  acute  inflammation   of  the  mucous  membrane  of    the 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  65 

large  intestines,  characterized  by  fever,  tenesmus,  and  frequent 
stools  composed  largely  of  mucus  and  blood. 

What  are  the  causes  ? 

Excessive  heat,  exposure  to  cold,  and  bad  food.  There  are 
two  forms,  namely  the  sporadic  and  epidemic.  Tlie  epidemic 
form  is  said  to  be  both  infectious  and  contagious.  The  disease 
is  more  common  in  boys  than  in  girls,  and  usually  occurs  in  the 
second  or  third  years  of  life. 

What  are  the  symptoms  ? 

The  attack  is  ushered  in  with  nausea,  vomiting,  fever,  and 
acute  abdominal  pain.  The  stools  are  numerous  and  small  in 
quantity,  ranging  from  four  to  forty  in  the  twenty-four  hours, 
and  are  voided  with  much  straining  and  discomfort.  At  first 
they  contain  fecal  matter,  but  as  the  disease  progresses  they 
are  composed  entirely  of  mucus  and  blood  mixed  in  a  dirty 
yellowish  fluid  most  offensive  to  the  odor.  There  is  restless- 
ness, sleeplessness,  and  rapid  emaciation.  The  tongue  is  red 
and  dry,  covered  in  the  centre  with  a  dark  coating.  There  is 
fever  and  intense  thirst.  The  abdomen  is  much  distended  and 
painful  on  pressure  over  the  region  of  the  colon. 

As  the  attack  progresses  tenesmus  occurs  without  the  pas- 
sage of  stools,  and  often  causes  prolapse  of  the  rectum.  The 
fever  is  replaced  by  a  coolness  of  the  surface.  Tlie  face 
becomes  pinched,  the  cheeks  sunken,  and  death  may  either  take 
place  from  exhaustion  or  be  preceded  by  slight  convulsions. 

In  grave  cases  the  attack  lasts  from  one  to  three  days ;  in 
favorable  cases  about  two  weeks. 

What  is  the  diagnosis? 

High  fever,  tenesmus,  tenderness  of  the  abdomen,  and  the 
number  and  character  of  the  stools. 

What  is  the  prognosis? 

Favorable  in  the  sporadic  form  and  when  there  is  only  a 
5 


G6  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

sliglit  elevation  of  temperature  and  a  few  stools.  On  the  other 
hand,  if  the  fever  be  high,  and  frequent  evacuations  containing 
much  mucus  and  blood,  great  tenesmus ;  when  there  is  a  ten- 
dency to  collapse,  the  prognosis  is  grave. 

What  is  the  treatment? 

The  child  must  be  put  to  bed  in  a  well-ventilated  room,  and 
given  only  liquid  diet.  Small  pieces  of  ice  may  be  allowed  to 
be  sucked  to  relieve  the  intense  thirst ;  the  abdomen  should  be 
kept  covered  with  a  flax-meal  or  mush  poultice,  changed  every 
two  hours. 

If  the  patient  is  seen  early  it  is  well  to  clean  out  the  intes- 
tines by  small  doses  of  castor  oil  with  laudanum  (fifteen  drops 
of  castor  oil  with  one  drop  of  laudanum,  every  two  or  three 
hours,  for  a  child  of  three  years).  After  this  has  been  given 
for  twenty-four  hours  any  of  the  following  formulae  will  be 
found  useful : — 

^.     Pulv.  Ipecac.  Comp.  gr.  vj. 
Bismuth.  Subcarb.  5J' 
Pulv.  Aromat.  gr.  vj. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  every  three  hours.     (Starr.) 

This  should  be  followed  by  an  enema  of  laudanum — gtt.  iij  to 
^ss  of  tepid  water  every  four  hours.  If  this  should  fail  use  the 
followin<j : — 

^.     Pulv.  Opii  gr.  ss. 

Plumbi  Acetat.  gr.  j. 

01.  Theobromse  5j' 
M.  et  ft.  sulph.  No.  vi. 
Sig.  Use  one  every  four  to  six  hours. 

^.     Liq.  Ferri  Pernitrat., 

Acid.  Nitric,  dil.  aa  5ss. 
Syr.  Simp.  f^j. 

Aquse  Cinnam.  q.  s.  ad  f  §iij. — M. 
Sig.  Teaspoonful  every  three  hours.     {Ellis.) 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  G7 

Should  the  above  fail,  nitrate  of  silver  in  doses  from  25  to  ^^ 
of  a  grain  should  be  suspended  in  syrup  of  acacia,  and  given 
every  three  or  four  hours. 

Stimulants  should  be  employed  from  the  beginning  of  the 
attack.  When  convalescence  is  reached  the  diet  should  still 
be  guarded  and  the  general  health  kept  up  with  tonics,  such  as 
quinine,  tincture  of  nux  vomica,  etc. 

Intussusception. 

What  is  the  synonym? 
Invagination. 

What  is  the  definition? 

When  one  piece  of  intestine  passes  into  a  piece  immediately 
continuous  with  it,  the  intussusception  being  the  tumor  so 
formed. 

The  most  common  form  is  w^hen  the  ileo-caecal  valve  and  the 
lower  part  of  the  ileum  are  received  into  the  colon,  and  the 
tumor  is  made  up  by  the  colon  externally  (ensheathing  layer), 
the  ileo-caecal  valve  and  caecum  within  this  (returning  layer), 
and  the  lower  part  of  the  ileum,  internally  (entering  layer). 

What  are  the  symptoms? 

Vomiting ;  expulsion  of  blood  and  mucus  per  anum ;  the 
presence  of  an  elongated  doughy  tumor  in  the  region  over  the 
colon  ;  or  a  polypoid  mass  of  mucous  membrane  protruding 
from  the  anus;  pain,  sudden  collapse,  etc.  It  is  important  to 
remember  that  unless  the  intussusception  be  strangulated  it 
may  be  obscured  by  symptoms  of  catarrhal  enteritis. 

What  are  the  symptoms  of  strangulation  ? 

A  cry  of  pain,  obstinate  vomiting,  fecal  retention,  passage 
of  blood  with  mucus,  and  even  before  these  symptoms  there  is 
an  aspect  of  severe  illness,  which  comes  on  suddenly,  which 
should   be   carefully   noted  as  suggestive   of  serious    trouble, 


68  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

where  other  more  distinctive  features  are  yet  in  abeyance. 
Vomiting  being  so  common  an  affection  of  infancy  is  liable  to 
pass  without  much  attention,  but  when  it  is  accompanied  by 
restlessness  and  abdominal  pain,  and  the  quick  onset  of  extreme 
pallor,  it  should  always  call  attention.  Death  from  intussus- 
ception may  ensue,  with  no  other  symptoms  than  these,  within 
twenty-four  or  thirty-six  hours. 

What  is  the  course  and  duration? 

In  infants  under  two  years  it  is  almost  invariably  fatal  in  a 
few  days,  but  in  older  children  a  spontaneous  cure  by  the 
sloughing  of  the  invaginated  mass  may  be  hoped  for. 

What  is  the  prognosis? 

When  acute  in  very  young  children  the  treatment  is  usually 
unsuccessful,  and  the  child  dies.  In  older  children  it  is  more 
favorable. 

What  is  the  treatment? 

The  invaginated  portion  of  an  acute  intussusception  must  be 
returned.  The  deodorized  tincture  of  opium  may  be  given  in 
drop  doses  as  may  be  required  to  quiet  the  action  of  the  bowel ; 
the  abdomen  should  be  covered  with  a  mush  poultice,  con- 
stantly changed  as  it  becomes  cold,  and  small  doses  of  bella- 
donna and  hydrocyanic  acid  may  also  be  found  of  service. 

If  the  symptoms  are  not  relieved,  reduction  must  be  at- 
tempted without  delay  by  manipulation,  inflation,  or  by  a 
forced  enema  of  water  or  oil,  when  an  anaesthetic  must  be 
given. 

How  should  manipulation  be  performed? 

The  legs  should  be  flexed  so  as  to  relax  the  abdominal 
muscles,  then  the  tumor  must  be  grasped  between  the  fingers 
and  gently  squeezed.  In  this  way  it  may  be  partially  reduced, 
but  complete  reduction  is  rarely  effected. 


DISEASES    OP    THE    STOMACH    AND    INTESTINES.  69 

How  should  inflation  be  performed  ? 

Attach  to  a  bellows  a  stout  piece  of  flexible  rubber  tubing, 
with  a  vaginal  end  which  should  be  carefully  inserted  into  the 
rectum.  The  buttocks  must  be  held  tightly  around  it,  and 
air  is  then  pumped  into  the  colon,  at  the  same  time  the 
abdomen  being  manipulated  by  an  assistant.  Although  there 
are  now  many  cases  that  have  been  treated  by  this  method 
successfully,  distention  by  water  is  to  be  preferred. 

How  should  forced  injections  be  performed? 

An  ordinary  enema  apparatus  may  be  employed,  and  as 
much  tepid  water  should  be  thrown  into  the  bowels  as  possible. 
The  water  used  should  be  first  boiled  and  then  allowed  to  cool 
to  a  temperature  of  about  100°  F.  Dr.  Goodhart  states  that 
by  this  method  he  has  been  able  to  reduce  an  intussusception 
that  was  well  down  into  the  rectum. 

When  should  laparotomy  be  performed? 

After  all  the  above  measures  have  failed.  This  operation  is 
usually  fatal  in  children  under  the  age  of  six  years,  but  as  a 
last  resort  should  always  be  tried.  Early  operation  gives  the 
best  security  against  finding  the  intussusception  irreducible. 

Worms. 

How  many  varieties  of  worms  infest  the  alimentary  canal  of 
children  ? 
Four. 

Name  them  ? 

The  oxyuris  vermicularis,  the  ascaris  lumbricoides,  the 
taenia  mediocanellata,  and  the  taenia  solium. 

Where  does  the  oxyuris  vermicularis  inhabit  ? 
The  colon. 

Describe  it. 

It  is  a  whitish  worm,  the  female  is  a  quarter  to  a  half  inch 


70  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

in  length,  the  male  being  smaller  with  a  marked  curve  at  its 
blunted  tail. 

Describe  the  eggs. 

They  are  oval,  with  a  flattened  surface,  and  usually  contain 
a  formed  embyro. 

How  are  they  introduced  into  the  system  ? 

By  the  mouth  to  the  stomach  when  they  are  hatched  and 
pass  onward  to  the  large  intestines. 

Describe  the  ascaris  lumbricoides. 

It  is  round  resembling  the  common  garden  worm.  The  male 
measures  from  four  to  six  inches  in  length,  and  the  female  ten 
or  twelve  inches. 

Describe  the  eggs. 

They  are  oval  in  shape,  are  gj^  inch  in  length  having  a 
nodulated  shell. 

Where  do  they  inhabit  ? 

The  small  intestines  in  numbers  varying  from  three  to  five. 

How  are  they  introduced  into  the  system  ? 

They  are  taken   into  the  stomach   by  means  of  unfiltered 

water  and  unwashed  food. 

Describe  the  taenia  solium  and  taenia  mediocanellata. 

The  tainia  solium  is  from  four  to  twenty  feet  in  length,  its 
head  is  globular  in  shape  and  its  slender  neck  connects  its 
numerous  flat  segments  or  joints.  The  head  measures  about 
:^Q  of  an  inch  and  is  armed  with  two  circles  of  hooks,  and  is 
also  provided  with  from  two  to  four  suckers.  The  joints  are 
flat,  varying  from  one-eighth  to  one-half  an  inch  in  length, 
they  each  contain  male  and  female  sexual  organs.  The  ova 
measures  xtoo  ^^  ^^  ^^^^  ^^  diameter.  A  tape  worm  is  sup- 
posed to  contain  about  five  million  ova. 

The  taenia  mediocanellata  varies  from  ten  to  thirty  feet  in 
length.     The  head  is  oval  in  shape,  has  four  strong  suckers, 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  71 

but  no  hooks,  and  measures  about  ^^  of  an  inch.  The  neck  is 
short  and  thick,  and  the  seojments  are  much  thicker  and  stronger 
than  those  of"  the  taenia  solium. 

What  are  the  symptoms  caused  by  the  oxyuris  vermicularis  ? 

Intense  itching  about  the  anus,  frequent  desire  to  stool,  the 
latter  containing  much  mucus,  caused  by  the  irritation  of  the 
seat  worms. 

What  are  the  symptoms  caused  by  the  ascaris  lumbricoides  ? 

Often  no  characteristic  symptoms  are  present  other  than 
gastric  and  intestinal  irritation,  such  as  foulness  of  the  breath, 
grinding  of  the  teeth  during  sleep,  diarrhoea,  nausea  and 
vomiting,  picking  the  nose,  etc. 

What  are  the  symptoms  caused  by  the  taenia  solium  and  taenia 
mediocanellata  ? 

They  frequently  produce  no  symptoms,  although  in  some  cases 
the  child  is  restless  and  complains  of  colicky  pains,  pruritus  of 
the  anus  and  nose:  The  bowels  are  usually  confined,  the 
appetite  is  inordinate,  indigestion,  emaciation,  and  cardiac 
palpitation. 

What  is  the  treatment  for  the  oxyuris  vermicularis  ? 

■  The  lower  bowel  should  first  be  cleaned  by  an  enema  of 
warm  water  and  soap,  then  an  injection  of  the  infusion  of 
quassia  (Oj),  to  which  may  be  added  ferri  sulphat.  5j?  a  third 
part  to  be  injected  on  alternate  mornings.  Simple  salt  and 
water,  lime  water,  or  alum  and  water  (5j  to  Oj)  may  also  be 
employed.  "While  the  injections  are  being  used  any  one  of  the 
following  may  be  employed  with  good  results  : — 

]^.     Santonini  gr.  j-4j. 

Hydrarg.  Chlor.  Mit.  gr.  j-iij. 
Pulv.  Aroruat.  gr.  iv. 
M.  et  ft.  chart.  No.  iv. 
Sig.  One  at  bedtime  to  be  followed  by  a  dose  of  castor  oil  iu  the 
morulug. 


72  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Or, 

SJL.     Hydrarg.  Chlor.  Mit.  gr.  j, 
Resinse  Jalapae  gr.  ij. 
Pulv.  Scammonii  gr.  v. 
M.  et  ft.  chart.  No.  i. 
Sig.  To  be  taken  at  bedtime  for  a  child  of  six  years. 

(Goodhart  and  Starr.) 

What  is  the  treatment  for  the  ascaris  lumbricoides  ? 

Santonin  is  considered  the  best.  It  may  be  given  in  a 
powder  with  calomel  as  recommended  for  seat  worms,  or  the 
officinal  santonin  chocolates  may  be  used.  The  dose  should 
be  from  one-quarter  to  one  grain  three  times  a  day,  and  after 
it  has  been  given  from  one  to  two  days  it  must  be  followed 
by  a  purgative  such  as  castor  oil,  or  one  grain  of  jalap  resin  in 
milk.  The  fluid  extract  of  spigelia  and  senna  will  be  found 
useful  and  convenient  as  no  purgative  is  required  to  follow  its 
administration.  Any  of  the  following  formulae  will  be  found 
useful : — 

;^.     01.  Chenopodii  f  5iiss. 

01.  Ricini  i^v. 

Olei  Menthse  Pip.  TU^'j. 

Syr.  Acacise  q.  s.  ad  f^iij. — M. 
Sig.  Teaspoonful  three  times  a  day  for  a  child  of  three  years. 

^.     01.  Chenopodii  f  5J- 
01.  Terebinth,  f  5ij. 

Emul.  01.  Ricini.  50  %  q.  s.  ad  ffij.— M. 
Sig.  Teaspoonful  twice  daily. 

What  is  the  treatment  for  the  taenia  solium  and  the  taenia 
mediocanellata  ? 
The  oil  of  male  fern  is  one  of  the  best  remedies  for  children, 
half  teaspoonful  may  be  given  to  a  child  of  six  years,  the  fol- 
lowing makes  a  very  effectual  remedy : — 

]^.     01.  Filicis  Maris  f  5iij« 
01.  Chenopodii  f  5j. 
01.  Terebinth,  f  5ij. 

Emul.  01.  Ricini  50  %  q.  s.  ad  f  ^ij.-— M. 
Sig.  Teaspoonful  twice  a  day 


DISEASES    OF    THE    STOMACH    AND    INTESTINES.  73 

A  decoction  of  pomegranate-root  bark  may  be  found  useful 
in  doses  from  one  to  two  tablespoonfuls.  Powdered  kamala 
may  be  used,  given  with  a  little  syrup,  or  the  tincture  may  be 
employed. 

1^.     Tr.  Kamalse  f5ss. 
Syr.  Zingiber.  f5j. 
Syr.  Acaciae  f  S^s. — M. 
Sig.  Take  at  one  dose  at  bedtime,  followed  by  a  purge  in  the  morn- 
ing. 

Tanret's  pelletierine  is  a  most  valuable  remedy.  It  is  dis- 
pensed in  bottles  containing  the  proper  dose  for  an  adult,  for 
children  from  nine  to  twelve  years  half  the  adult  dose  is  given. 

In  using  the  remedies  mentioned  the  administration  of  a 
purgative  for  one  or  two  days,  and  a  light  liquid  diet  should 
precede  their  use. 


74  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

PART   IV. 

Diseases  of  the  Liver. 
Icterus  Neonatorum. 

What  is  the  definition  ? 

A  jaundice  occurring  within  a  few  days  of  birth,  and  dis- 
appearing usually  within  a  week. 

What  are  the  causes  ? 

It  occurs  commonly  in  infants  prematurely  born  with  feeble 
constitutions,  and  is  dependent  on  defective  respiration  and 
impaired  performance  of  the  functions  of  the  skin. 

What  is  the  treatment? 

Nothing  is  required  beyond  keeping  the  bowels  open  and 
the  child  warm. 

Jaundice. 

What  is  the  definition? 

An  acute  catarrhal  inflammation  of  the  mucous  membrane 
of  the  bile  ducts  and  of  the  duodenum. 

What  are  the  causes  ? 

Supposed  to  be  due  to  catarrh  of  the  bile  ducts  and  duodenal 
catarrh. 

What  are  the  symptoms  ? 

Yellow  discoloration  of  the  skin,  itching,  yellowness  of  the 
conjunctivae,  dark-colored  urine,  and  clay-colored  stools  devoid 
of  fecal  odor.  The  other  symptoms  are  headache,  vomiting,  a 
yellow  furred  tongue,  indigestion,  disturbed  sleep,  slowness  of 
the  pulse,  and  a  decrease  of  the  surface  temperature. 


DISEASES    OF    THE    LIVER.  75 

What  is  the  diagnosis  ? 

Cannot  be  mistaken  for  any  other  disease  when  the  discolo- 
ration of  the  skin  appears. 

What  is  the  treatment  ? 

The  child  should  receive  a  sponge  bath  daily,  followed  by  a 
gentle  friction  to  promote  the  activity  of  the  skin  ;  moderate 
doses  of  calomel  should  be  given,  followed  by  some  mild  laxa- 
tive, such  as  licorice  powder,  syrup  of  rhubarb,  fluid  magnesia, 
or  the  compound  decoction  of  aloes.  The  duodenal  catarrh  is 
best  relieved  by  alkalies.  Kissengen  or  Vichy  water  should 
be  drunk  with  each  meal,  and  the  following  mixture  adminis- 
tered :— 

I^.     Ammon.  Chlor.  5^ss. 
Elix.  Simp,  f^iij.— M. 
Sig.  Teaspooiiful  in  water  three  times  a  day  after  eating  for  a  child 
of  five  years.  * 

Cirrhosis  of  the  Liver. 

What  are  the  synonyms? 

Interstitial  hepatitis  ;  hob-nailed  liver. 

What  is  the  definition  ? 

An  inflammation  of  the  connective  tissue  of  the  liver,  re- 
sulting in  an  induration  of  the  organ  and  atrophy  of  the  secre- 
ting cells ;  characterized  by  slight  jaundice,  gastro-intestinal 
catarrh,  emaciation,  and  ascites. 

What  are  the  causes? 

Alcoholic  excess,  the  chief  cause  in  adults,  is  of  course  out 
of  the  question  in  children,  except  in  very  rare  cases.  Some 
authorities  believe  it  is  caused  by  intemperate  parents.  Con- 
genital deficiency  of  the  bile-duct  is  always  accompanied  by 
cirrhosis.  Constitutional  syphilis  and  general  tuberculosis 
often  precede  it.  It  is  more  frequent  in  boys  than  in  girls,  and 
is  usually  met  with  between  the  sixth  and  twelfth  years  of  life. 


76  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  morbid  anatomy  ? 

There  are  two  ("orms,  atrophic  and  hypertrophic.  The  liver 
is  granular  and  fibrous  throughout  and  may  be  extensively 
scarred.  The  histological  changes  are  those  mostly  attending 
the  more  chronic  forms  of  the  disease — that  is  to  say,  more 
fibrous  than  cellular.  The  earlier  stages  of  enlargement  of 
the  viscus  and  new  growth  of  cell  elements  have  been  described 
as  in  adults,  and  no  doubt  occur,  but  are  likely  to  escape  notice 
until  the  onset  of  ascites. 

What  are  the  symptoms  of  the  atrophic  forms? 

In  atrophic  cirrhosis  the  child  is  fretful  and  sleeps  badly  at 
night.  The  bowels  are  constipated,  the  complexion  is  pale 
"with  dark  circles  under  the  eyes.  The  muscles  grow  flabby, 
the  urine  is  filled  with  lithates,  or  is  acid  in  reaction  and  de- 
posits a  sediment  of  uric  acid.  After  these  symptoms  have 
been  present  for  some  time,  ascites  and  pain  in  the  region  of  the 
liver  are  developed.  The  ascites  causes  a  prominence  in  the 
abdomen  with  a  marked  dilatation  of  the  superficial  abdominal 
veins.  The  liver  and  spleen  are  enlarged  ;  the  former  soon 
begins  to  decrease  in  size,  but  the  latter  continues  to  increase 
in  size.  The  patient  now  becomes  weaker  and  the  ascites  is 
more  marked ;  the  feet  and  legs  are  oedematous,  the  skin  is 
sallow,  tongue  coated,  and  appetite  almost  lost.  The  bowels 
may  be  confined  or  relaxed ;  there  is  much  abdominal  pain ; 
hemorrhages  may  occur  from  the  stomach,  bowels,  and  nose. 

Severe  diarrhoea,  general  dropsy,  or  hemorrhages  are  usually 
fatal  signs. 

What  are  the  symptoms  of  the  hypertrophic  form? 

The  skin,  conjunctivae,  and  urine  are  stained  by  bile,  and  the 
stools  are  clay-colored.  The  liver  and  spleen  are  both  enlarged, 
but  there  is  no  distention  of  the  abdominal  veins  or  ascites. 
The  jaundice  and  enlargement  of  the  liver  may  increase 
rapidly ;  then  a  moderate  fever  is  present,  with  intense  pain  in 


DISEASES    OF    THE    LIVER.  77 

the  right  hypochondrium.  As  the  end  approaches  the  pulse 
becomes  weak  and  irregular ;  the  tongue  is  dry  and  brown  ; 
there  is  rapid  wasting  ;  bleeding  from  the  gums,  stupor,  and  at 
last  convulsions. 

What  is  the  diagnosis  of  the  atrophic  form? 

Diminution  in  the  area  of  liver  dulness  ;  enlargement  of  the 
spleen ;  ascites ;  dilatation  of  the  abdominal  veins ;  a  dry 
sallow  skin ;  gastro-intestinal  hemorrhages  unaccompanied  by 
fever  in  a  child  who  has  a  history  of  prolonged  ill-health. 

What  is  the  diagnosis  of  the  hypertrophic  form  ? 

Marked  enlargement  of  the  liver  and  spleen,  but  no  ascites  ; 
fever,  jaundice  ;  pain  over  the  hepatic  region.  Following  these 
symptoms  are  malignant  jaundice,  rapid  wasting,  the  typhoid 
state,  coma  and  convulsions. 

What  is  the  prognosis? 

Always  unfavorable. 

What  is  the  treatment  ? 

Symptoms  should  be  treated  as  they  arise.  The  imperfect 
digestion  should  be  corrected  with  the  follow^ing : — 

T^.     Pepsinae  Pulv.  gr.  xxir. 
Sodii  Bicarb,  gr.  xxxvj. 
Pulv.  Aromat.  gr.  xij. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  three  times  a  day  after  eating. 

When  the  hepatic  trouble  manifests  itself  alkalies  and  tonics 
are  indicated,  any  of  the  following  will  be  found  useful ; — 

^.     Sodii  Bicarb.  5ij- 

Tr.  Nucis  Vom.  n\^xviij. 
Infus.  Calumbae  q.  s.  ad  f^iij- — M. 
Sig.  Two  teaspoonfuls  three  times  daily  for  d  child  of  ten  years. 

{Starr.) 


78  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Or, 

^.     Quinige  Sulphat.  gr.  viij. 
Tr.  Ferri  Cblor.  f5ss. 
Syr.  Limonis  fSU- 
AqiTse  q.  s.  ad  t^ij. — M. 
Sig.  Teaspoonful  three  times  a  day. 

Or, 

R.     Tr.  Nucis  Vomicae  TTLxij-xxir. 

Elix.  Calisayse  q.  s.  ad  f  §iij. — M. 
Sig.  Teaspoonful  three  times  a  day  diluted. 

The  constipation  may  be  relieved  by  the  use  of  some  laxa- 
tive, as  citrate  of  magnebia — one  or  two  wineglassf'uls  before 
breakfast.  The  diarrhoea  should  be  controlled  by  the  follow- 
ing bismuth  mixture  : — 

;^.     Bismuth  Suhcarb.  5iss. 
Spt.  Myristicse  Tilxij. 
Spt.  Vini  Gal.  f  §ss. 
Syr.  Acacise  §j. 

Aquge  Cinuam.  q.  s.  ad  f  §iij. — M. 
Sig.  Teaspoonful  every  two  or  three  hours  as  required. 

The  hemorrhages  should  be  treated  by  gallic  acid,  Monsell's 
solution,  or  aromatic  sulphuric  acid. 

The  child  should  be  kept  on  a  diet  of  milk,  eggs,  meat 
broths,  etc. 

A  warm  bath  may  be  given  daily,  followed  by  gentle  rubbing 
with  a  moderately  coarse  towel  to  keep  the  skin  active. 

Should  the  ascites  impede  the  action  of  the  diaphragm, 
paracentesis  should  immediately  be  performed. 

Syphilitic  Hepatitis. 

What  is  the  morbid  anatomy  ? 

The  liver  is  the  seat  of  acute  swelling,  without  showing 
much   change   to  the    naked   eye,  associated   with  a  diifused 


DISEASES    OF    THE    LIVER.  i 'J 

growth  of  connective  tissue  throughout  the  organ,  either 
scattered  or  gathered  into  miliary  gummata.  When  jaundice 
occurs,  the  bile-ducts  are  thickened  and  occluded  by  epithelial 
cells,  and  the  organ  is  brownish-yellow  in  color  and  enlarged. 

What  are  the  symptoms  ? 

In  mild  cases  they  are  obscure ;  in  the  grave  there  are 
jaundice,  ascites,  ecchymosis  of  the  skin,  subnormal  tempera- 
ture, hemorrhage  from  umbilicus  and  intestines,  emaciation. 
On  palpation  the  liver  and  spleen  are  found  to  be  enlarged. 

What  is  the  diagnosis  ? 

Early  age,  history  of  hereditary  syphilis,  enlarged  liver  with 

jaundice  and  ascites. 

What  is  the  prognosis  ? 

Usually  unfavorable,  although  Goodhart  says  that  his  cases 
did  well  on  a  mercurial  course,  which,  by  the  way,  does  not 
correspond  with  the  experience  of  American  practitioners. 

What  is  the  treatment  ? 

Mercurials,  with  tonics  and  the  iodide  of  potassium.  Any 
of  the  following  formulae  will  be  found  valuable  : — 

^..     Hydrarg.  cum  Cretse. 

Sacch.  Lact.  aa  gr.  xij. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  night  and  morning. 

B.     Hydrarg.  Chlor.  Mit.  gr.  j. 

Sacch.  Lact.  gr.  viij. 

Pulv.  Aromat.  gr.  iv. 
M.  et  ft.  chart.  No.  viii. 
Sig.  One  powder  night  and  morning. 

]^.     Hydrarg.  Bichlor.  gr.  ^-^. 
Potass.  lodid.  gr.  xvj-xxxij. 
Syr.  Sarsap.  Corap.  ^ss. 
Aquae  q.  s.  ad  f  ^ij. — M. 
Sig.  Teaspoonful  niglit  and  morning. 


80  ESSENTIALS    OF    DISEASES    OP    CHILDREN. 

Another  valuable  way  of  giving  mercury  is  by  the  mercurial 
ointment.  Ten  grains  of  the  ointment  may  be  rubbed  into  the 
skin  once  a  day. 

The  syrup  of  the  iodide  of  iron  is  useful  after  the  liver  has 
been  reduced  in  size ;  it  may  be  given  in  two  or  three  drop- 
doses  in  malt  extract  or  water  three  times  a  day. 

For  the  splenic  enlargement  the  following  should  be  rubbed 
in  over  the  splenic  region  night  and  morning. 

I^.     Uiigt.  lodini  Comp.  5ss. 
Vaseline  5^ij- — M« 
Sig. 


DISEASES    OF    THE    PERITONEUM.  81 

PART   V. 

Diseases  of  the  Peritoneum. 

Peritonitis. 

What  is  the  synonym? 

Inflammation  of  the  peritoneum. 

What  is  the  definition  ? 

A  fibrinous  inflammation  of  the  peritoneum,  characterized 
by  fever,  abdominal  pain,  tenderness,  vomiting,  and  general 
prostration. 

What  are  the  causes? 

Foetal  peritonitis  is  caused  by  syphilis.  The  first  few  days 
of  life  it  may  be  due  to  suppuration  or  gangrene  of  the  umbilicus. 

Later  in  childhood  it  is  caused  by  blows  or  other  injuries  to 
the  abdomen;  sudden  chilling  of  the  body,  lying  on  damp 
ground  after  violent  exercise.  It  may  also  occur  after  scar- 
latina or  other  fevers.  It  is  more  frequently  secondary  than 
primary;  i.e.,  it  is  usually  an  extension  from  some  disease  of 
the  viscera  which  the  serous  membrane  envelops. 

Chronic  peritonitis  often  follows  an  acute  attack,  but  it  most 
commonly  appears  with  tuberculosis,  and  shows  the  characters 
of  chronicity  from  the  outset. 

What  are  the  symptoms  ? 

The  attack  is  ushered  in  with  rigors  and  vomiting  of  mucus  ; 
intense  abdominal  pain  increased  by  pressure,  coughing,  and 
vomiting.  The  face  is  pale  and  pinched,  the  knees  drawn  up. 
The  abdomen  is  much  distended  ;  the  tongue  is  dry  and  coated, 
loss  of  appetite  is  marked.  The  bowels  are  constipated,  the 
temperature  much  above  normal,  the  pulse  frequent,  the  respi- 
ration retarded.  In  infants  usually  convulsions,  in  older  chil- 
dren delirium. 
6 


82  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

In  the  chronic  form  the  pain  lessens,  the  fever  is  remittent. 
Constipation  alternates  with  diarrhoea. 

What  is  the  diagnosis  ? 

The  child  lies  on  his  back  with  legs  flexed,  the  face  is  pale 
and  pinched  ;  the  pulse  is  frequent  and  wiry  ;  temperature -from 
103°  to  104°  F.     There  are  distention,  tenderness  on  pressure 
and  acute  pain  in  the  abdomen  ;  and  inactivity  of  the  abdominal 
muscles  in  respiration. 

What  is  the  diagnosis  from  colic  ? 

Constipation  and  vomiting,  with  pain  ;  no  abdominal  tender- 
ness between  the  paroxysms,  and  the  pulse  is  never  so  wiry, 
rapid,  and  small.  There  is  no  fear  of  movement,  as  in  perito- 
nitis. 

What  is  the  prognosis  ? 

Usually  grave.     Perforative  peritonitis  is  always  fatal. 

What  is  the  treatment? 

Rest  in  bed,  hot  applications  to  the  abdomen,  such  as  flax- 
meal  poultices,  turpentine  stupes,  or  other  hot  fomentations. 
The  food  should  be  liquid  and  iced  drinks  may  be  given. 
Opium  should  be  given  freely,  either  by  the  mouth,  rectum,  or 
hypodermically.  Any  of  the  following  prescriptions  will  be 
found  of  value  : — 

1^.     Tr.  Opii  TTLxvj. 

Syr.  Zingiber,  f  ^j. 
Aqnse  q.  s.  ad  f  ^ij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  five  years. 

R.     Pulv.  Opii  gr.  j-ij. 

Sacch.  Lact.  gr.  xij. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  every  two  hours. 

A  hypodermic  injection  of  the  sulphate  of  morphia  may  be 
employed,  starting  with  one-twentieth  of  a  grain  for  a  child  of 
five  years,  to  be  repeated  as  necessary. 


DISEASES    OF    THE    PERITONEUM.  83 

Should  the  bowels  be  very  much  constipated,  a  simple  enema 
must  be  given.  If  the  inflammation  decreases,  the  opium 
may  be  gradually  withdrawn,  substituting  a  tonic  treatment 
with  mercury,  iodide  of  potash  in  alterative  doses.  If  there  Is 
evidence  of  failing  strength,  whiskey  should  be  given  in  the 
milk.  After  the  hot  applications  have  been  removed,  the  abdo- 
men should  be  rubbed  with  a  weak  mercurial  ointment. 

I^.      Ungt.  Hydrarg., 

Vaseliui  aa  ^ds. — M. 
Sig.  Rub  well  into  the  skin  over  abdomen  niglit  and  morning. 

Ascites. 

What  are  the  synonyms  ? 

Abdominal  dropsy  ;  dropsy  of  the  peritoneum. 

What  is  the  definition  ? 

A  collection  of  serous  fluid  in  the  peritoneal  cavity;  charac- 
terized by  distention  of  the  abdomen,  fluctuation,  and  dulness 
on  percussion. 

What  are  the  causes  ? 

Simple  or  tubercular  inflammation  of  the  peritoneum ;  dis- 
eases of  the  heart  and  liver ;  enlargement  of  the  mesenteric 
glands,  and  occasionally  disease  of  the  lungs. 

What  are  the  symptoms  ? 

If  there  be  much  fluid  present,  the  abdominal  wall  is  arched, 
and  fluctuation  is  present.  If  the  patient  is  placed  on  his  back, 
the  percussion  note  over  the  upper  and  anterior  parts  of  the 
abdomen  will  be  tympanitic,  but  a  change  in  position  will  alter 
the  areas  of  dulness  and  tympany.  The  umbilicus  may  pro- 
trude, and  the  superficial  veins  are  prominent.  The  respira- 
tion is  labored,  the  bowels  are  usually  constipated,  the  urine  is 
scant,  containing  albumen  and  blood. 


84  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  diagnosis  ? 

Only  difficult  when  the  amount  of  fluid  is  very  small. 

What  is  the  prognosis  ? 

In  children  with  good  constitutions  usually  favorable. 

^at  is  the  treatment  ? 

Depends  principally  upon  the  cause.  The  first  points  to 
bear  in  mind  are  to  reduce  the  amount  of  fluids  given  the 
child,  and  if  the  cause  is  not  known,  the  administration  of  iron. 
Diuretics  and  hydragogue  cathartics  should  be  given. 

'EIl.     Ferri  et  Potass.  Tart.  5iss. 
Syr.  Scillffi  f§j. 
Potass.  Acetat.  5iss- 
Spt.  ^ther.  Nit.  f  ^ss. 
Liq.  Ammon.  Acetat.  q.  s.  ad  f^iij. — M. 
Sig.  Teaspoonful  every  three  hours  for  a  child  of  five  years. 

^.     Tr.  Digitalis  n\^lxxij. 
Potass.  Acetat.  5'ss. 
Spt.  .^th.  Nitro.  f fss. 
Liq.  Ammon.  Acetat.  q.  s.  ad  f  §iij. — M. 
Sig.  Teaspoonful  every  three  hours. 

Should  the  above  treatment  be  tried  for  some  time  and  the 
fluid  does  not  diminish,  paracentesis  should  be  resorted  to. 
After  the  fluid  is  withdrawn  the  abdomen  must  be  carefully 
bandaged,  and  a  firm  pressure  kept  up  for  some  time. 


ACUTE    INFECTIOUS    DISEASES.  85 

PART    VI. 

Acute  Infectious  Diseases. 
Measles. 

What  are  the  synonyms  ? 

Morbilli ;  rubeola. 

What  is  the  definition  ? 

An  acute  epidemic  and  contagious  disease,  ushered  in  with 
catarrhal  symptoms,  fever,  and  characterized  by  an  eruption 
on  the  skin  appearing  the  fourth  day. 

What  is  the  cause? 
A  specific  poison. 

What  are  the  symptoms  ? 

After  a  period  of  incubation  from  twelve  to  fourteen  days, 
the  attack  is  ushered  in  by  a  chill,  then  fever,  quick  pulse, 
pain  in  the  legs,  headache,  followed  by  redness  of  the  eyes, 
coryza,  and  a  hoarse  cough.  On  the  fourth  day  the  eruption 
appears,  first  about  the  temples  and  face  in  the  form  of  small, 
dull-red  papules,  and  gradually  spreads  over  the  whole  body ; 
the  spots  coalesce,  and  present  a  peculiar  crescentic  appearance, 
disappearing  on  pressure.  The  fever  continues  during  the 
eruption  ;  the  cough  increases  ;  the  throat  is  dry  ;  the  eyes  are 
red,  and  in  strumous  children  are  apt  to  remain  so. 

When  the  eruption  begins  to  fade,  the  cough,  fever,  etc. 
decline.  The  temperature  reaches  its  maximum  (102°  to 
104°  F.)  with  the  initial  fever,  then  falls;  rises  again  when 
the  eruption  appears,  and  does  not  fall  till  the  eruption  fades. 

What  are  the  complications? 

Catarrhal  or  lobar  pneumonia ;  membranous  laryngitis  ; 
whooping-cough,  and  diarrh(jea. 


86  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  diagnosis  ? 

Chilliness,  coryza,  watery  eyes,  slight  cough  and  fever,  fol- 
lowed by  a  dull-red  crescentic  eruption  on  the  fourth  day. 

What  is  the  prognosis  ? 

If  uncomplicated,  favorable. 

What  is  the  treatment  ? 

Mild  cases  should  be  given  little  medicine;  the  child  must 
be  kept  in  one  room  of  an  even  temperature  of  68°  F. ;  the 
diet  should  be  regulated  and  consist  of  milk  and  light  broths. 
When  the  rash  appears,  the  child  should  be  put  to  bed ;  if  the 
skin  itches,  the  body  may  be  rubbed  with  carbolized  oil  or  cos- 
moline.  If  the  cough  is  troublesome,  the  following  mixture  will 
be  of  service  : — 

I^.     Tr.  Opii  Camp,  f  5iss. 
Spt.  ^th.  Nit.  f^ss. 
Syr.  Ipecac.  f5j. 
Syr.  Scillss  f^ss. 

Liq.  Pota.ss.  Citrat.  q.  s.  ad  f  fiij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  four  years. 

When  the  temperature  rises  above  103°  F.  an  antipyretic 
should  be  given  ;  one  grain  of  antifibrin,  to  begin  with,  may 
be  given  to  a  child  of  four  years,  to  be  repeated  as  required ; 
or  two  grains  of  sulphate  of  quinia,  by  the  mouth  or  rectum, 
every  three  or  four  hours.  Should  symptoms  of  exhaustion  or 
heart  failure  appear,  alcohol,  tincture  of  digitalis,  or  carbonate 
of  ammonium,  are  indicated.  During  convalescence  protect 
from  exposure  or  draughts  of  air ;  keep  on  tonic  treatment  for 
some  time  after,  with  proper  diet  and  change  of  air  and  scene, 
if  possible. 


Scarlet  Fever. 


What  is  the  synonym  ? 

Scarlatina. 


ACUTE    INFECTIOUS    DISEASES.  87 

What  is  the  definition  ? 

An  acute,  infectious,  and  contagious  disease,  characterized 
by  a  scarlet  rash,  sore  throat,  desquamation  of  the  cuticle,  and 
seldom  occurring  twice  in  the  same  person. 

What  are  the  causes  ? 

A  specific  poison.  It  spreads  by  infection,  and  is  communi- 
cated by  means  of  the  exhalations  and  secretions.  It  is  most 
contagious  during  the  eruption  and  desquamative  stages.  The 
germs  of  scarlatina  retain  their  vitality  for  long  periods.  It 
can  be  conveyed  by  clothing,  books,  letters,  etc.  The  incuba- 
tion is  from  one  to  seven  days. 

What  are  the  varieties  ? 

Simple,  anginose,  and  malignant. 

What  are  the  symptoms  ? 

Vomiting,  sore  throat,  headache,  fever,  rapid  pulse  (130-170 
beats  to  the  minute),  flushed  face,  high  temperature  (103°  to 
104°  F.  the  first  day),  hurried  breathing,  tongue  at  first 
coated,  afterwards  red,  with  prominent  papillfe,  known  as  the 
"  strawberry  tongue  ;"  hot"  skin,  and  intense  thirst.  On  the 
second  day  the  rash  appears,  first  upon  the  neck  and  upper  part 
of  the  chest.  It  is  scarlet,  consisting  of  innumerable  red  spots, 
at  first  separated  by  natural  skin,  but  soon  coalescing  and  pro- 
ducing a  general  redness,  which  is  not  elevated  to  the  touch. 
It  is  most  abundant  where  the  papillae  of  the  skin  are  the 
largest.  The  eruption  reaches  its  height  on  the  third  or  fourth 
day,  and  then  begins  to  gradually  fade,  disappearing  entirely 
by  the  eighth. 

About  the  fourth  or  fifth  day  the  fever  subsides ;  the  erup- 
tion gradually  fades,  and  desquamation  begins  about  the  eighth 
or  ninth  day. 

Describe  the  anginose  form. 

Tlie  swelling  of  the  glands  and  cellular  tissue  around  the 
neck  is  enormous ;  there  may  be  ulceration  of  the  fauces  and 


88  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

pharynx,  and  post-pharyngeal  abscess ;  the  mouth  is  opened 
with  difficulty,  and  the  inflammation  often  extends  to  the  ears 
through  the  Eustachian  tubes,  and  is  followed  by  a  purulent 
discharge  from  them. 

Describe  the  malignant  form. 

The  tonsils  become  the  seats  of  sloughing  ulcers,  leaving 
ugly  ragged  scars ;  the  excitement  is  great,  the  delirium  vio- 
lent, followed  by  extreme  exhaustion.  In  some  cases  the 
period  of  excitement  is  so  short,  and  so  soon  followed  by  the 
typhoid  state,  that  the  disease  may  prove  fatal  within  forty- 
eight  hours. 

What  are  the  complications? 

Ulceration  and  sloughing  of  the  fauces  and  pharynx  ;  retro- 
pharyngeal abscess,  scarlatina  bubo,  bronchitis,  pneumonia, 
pleurisy,  pericarditis,  otorrhoea,  diarrhcea,  rheumatism,  tender- 
ness and  swelling  about  the  joints,  chorea,  and  renal  dropsy. 

What  is  the  diagnosis  ? 

Sore  throat,  high  fever,  rapid  pulse,  the  character  and  early 
appearance  of  the  eruption  followed  by  desquamation. 

From  measles — no  catarrhal  symptoms  present,  and  the  early 
eruption. 

From  diphtheria — no  eruption,  great  prostration,  frequently 
complicated  with  scarlet  fever. 

From  smallpox — character  of  the  eruption ;  appearing  on 
the  third  day,  secondary  fever. 

What  is  the  prognosis? 

Usually  favorable  in  the  simple,  uncomplicated  form ;  the 
anginose  and  malignant  forms  are  grave. 

What  is  the  treatment  ? 

The  child  must  be  put  to  bed  in  a  large  well-ventilated 
room,  and  not  covered  with  a  superabundance  of  bed-clothing. 


ACUTE    INFECTIOUS    DISEASES.  89 

The  whole  body  sliould  be  greased  with  one  of  the  following 
ointments  night  and  morning  : — 

^.     Acid.  Carhol.  tt^xx. 
Vaseline  ^j. — M. 
Sig. 

^.     01.  Menthse  pip.  tt|_xv. 
01.  Olivse  fiij.— M. 
Sig. 

Milk  should  constitute  the  diet,  and  a  mild  aperient  may  be 
administered  every  few  days.  Cooling  drinks  may  be  given  ; 
and  should  the  temperature  run  very  high,  tepid  sponging  must 
be  resorted  to.  The  throat  symptoms  should  be  treated  with 
the  tincture  of  the  chloride  of  iron  and  chlorate  of  potassium. 

:^.     Tr.  Ferri  Chlor.  f  5j. 

Potass.  Chlorat.  gr.  xlviij. 
Glycerinse  f§j. 
Aquse  q.  s.  ad  ffiij. — M. 
Sig.  Teaspoonfal  every  two  hours  for  a  child  of  four  years. 

^.     Acid.  Boracic.  5ss. 
Potass.  Chlor.  5^1  • 
Tr.  Ferri  Chlor.  fSij. 
Glycerin  se, 
Syr.  Simp.,  aa  f^j. 
Aquse  f§ij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  five  years. 

(J.  Lewis  Smiih.^ 

Hot  poultices  or  compresses  should  be  kept  around  the  neck 
and  frequently  renewed. 

The  throat  should  be  kept  clear  by  the  use  of  a  spray  of 
DobelFs  solution,  if  the  child  be  old  enough  to  allow  the  pro- 
cedure. Stimulants  must  be  freely  given,  such  as  the  carbo- 
nate of  ammonium,  alcohol,  and  the  tincture  of  digitalis.  Tiie 
complications  must  be  treated,  excepting  the  nephritis,  on 
their  own  merits. 


90  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

For  scarlatinal  dropsy  the  child  should  be  put  to  bed  and 
kept  warm.  The  diet  should  be  fluid,  and  the  bowels  kept 
freely  opened  by  jalapin  (gr.  j),  or  by  the  daily  use  of  a  seid- 
litz  powder.  A  warm  bath  must  be  given  daily,  temperature 
of  the  water  being  about  100°-110°  F.  After  removing  the 
child,  he  should  be  wrapped  in  warm  blankets  and  put  back  to 
bed.  Should  these  measures  prove  unsuccessful,  dry  cupping 
and  frequent  hot  applications  may  be  made  to  the  lumbar 
region.     Digitalis  should  be  used  in  from  one  to  five  drop  doses. 

^.     Tr.  Digitalis  f5ss. 

Liq.  Ammon.  Acetat.  f^iss. 
Spt.  ^th.  Nit.  f  3ij. 
Syr.  Tolu  f^ss. 
Aquae  Cari  q.  s.  ad  f  §iij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  six  or  eight  years. 

(^Goodhart  and  Starr.) 

Tlie  tincture  of  digitalis  may  be  given  with  citrate  of  potas- 
sium. 

R.     Tr.  Digitalis  f  3ss. 
Elix.  Simp.  §ss. 

Liq.  Potass.  Citrat.  q.  s.  ad  f  fiij. — M. 
Sig.  Teaspoonful  every  two  hours. 

Should  suppression  of  the  urine  or  convulsions  manifest 
themselves,  free  purgation  must  be  secured,  and  the  bromide 
and  iodide  of  potassium  given  internally.  Dr.  Starr  highly 
recommends  the  infusion  or  fluid  extract  of  jaborandi  by  the 
mouth  in  connection  with  hot  packs. 

When  the  acute  symptoms  have  subsided  tincture  of  the 
chloride  of  iron  or  Basham's  mixture  should  be  given.  During 
convalescence  the  child  must  be  kept  warm,  wearing  flannel 
next  to  the  skin,  and  the  general  health  should  be  carefully 
looked  into  for  some  time  after.  Much  attention  should  be 
given  to  the  disinfection  of  the  room  and  the  child's  clothes, 
bedding,  etc. 


ACUTE    INFECTIOUS    DISEASES.  91 

Rotheln. 

What  are  the  synonyms  ? 

German  measles  ;  epidemic  roseola  ;  false  measles  ;  rubella. 

What  is  the  definition? 

A  contagious  eruptive  disease,  bearing  a  close  resemblance 
to  mild  cases  of  scarlet  fever  and  measles.  Characterized  by 
slight  fever,  watery  eyes,  slight  cough,  and  a  rose-colored  erup- 
tion, appearing  the  first  day.     Incubation  nine  to  fourteen  days. 

What  is  the  cause  ? 

Usually  direct  contagion. 

What  are  the  symptoms? 

Mild  fever,  watery  eyes,  sore  throat,  furred  tongue ;  some- 
times enlargement  of  the  cervical  glands.  The  rash  at  first 
closely  resembles  that  of  measles,  is  of  short  duration,  usually 
disappearing  in  a  day.    The  temperature  rarely  exceeds  100°  F. 

What  is  the  diagnosis? 

From  measles,  absence  of  severe  catarrhal  symptoms,  the 
character  and  late  appearance  of  the  eruption.  From  scarlet 
fever,  absence  of  high  fever  and  rapid  pulse,  color  and  char- 
acter of  eruption  ;  severe  throat  symptoms. 

What  is  the  prognosis? 

Always  favorable. 

What  is  the  treatment? 

Little  is  required  beyond  keeping  the  child  in  a  moderately 
warm  room,  giving  mild  laxatives,  and  regulating  the  diet. 
AVhen  the  fever  subsides  and  the  eruption  fades  any  itching  of 
the  skin  may  be  relieved  by  using  one  of  the  inunctions  given 
in  scarlet  fever. 


92  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Diphtheria. 

What  are  the  synonyms  ? 

Membranous  angina  ;  putrid  sore  throat. 

What  is  the  definition  ? 

An  acute,  specific,  infectious,  and  contagious  disease,  char- 
acterized by  a  local  exudation  and  glandular  enlargements; 
great  prostration  and  albuminuria. 

What  are  the  causes  ? 

A  specific  poison,  contagion,  bad  hygienic  surroundings ; 
may  occur  in  the  same  person  more  than  once.  The  period 
of  incubation  is  from  two  to  eight  days. 

What  is  the  morbid  anatomy  ? 

The  fauces  are  much  swollen  and  covered  with  lymph.  In 
severe  cases  the  uvula  and  , pharynx  are  sloughy-looking,  or 
the  tonsils  and  adjacent  mucous  membrane  are  much  thick- 
ened from  a  diffuse  inflammation.  The  mucous  membrane  of 
the  epiglottis  is  thickened,  and  a  tough  adherent  membrane 
lines  the  laryngeal  surface  of  the  epiglottis  and  the  interior  of 
the  larynx  above  the  true  vocal  cords.  A  leathery  layer  may 
extend  from  these  parts  over  the  edge  of  the  epiglottis  to  the 
base  of  the  tongue,  and  over  the  ary-epiglottic  folds  to  the  mu- 
cous membrane  of  the  pharynx,  and  the  reflection  of  mucous 
membrane  from  the  pharyngeal  aspect  of  the  larynx  to  the 
pharynx  proper  is  a  favorite  seat  for  the  membrane.  When 
the  trachea  is  reached  the  membrane  loses  its  toughness.  The 
color  of  the  membrane  is  a  grayish-white,  or  may  vary  from  a 
slio^ht  yellow  to  a  brownish -black.  When  the  membrane  is 
removed  a  raw,  bleeding  surface  is  shown,  which  is  quickly 
covered  with  a  new  deposit. 

The  glands  of  the  neck  are  much  enlarged  ;  the  muscular 
tissue  of  the  hearty  becomes  soft;  the  kidneys  may  undergo  a 


ACUTE    INFECTIOUS    DISEASES.  93 

granular   degeneration,  and   the  blood  is  much  altered,  being 
almost  black  in  color. 

What  are  the  symptoms  ? 

The  onset  is  usually  slow  ;  the  child  may  feel  languid,  com- 
plain of  chilliness,  pain  in  the  back,  headache,  thirst,  and 
fever.  On  inspection  the  throat  will  appear  red  and  swollen, 
with  small  patches  of  membrane  much  resembling  milk  curds. 
At  this  time  the  glands  beneath  the  angle  of  the  lower  jaw  are 
hard,  tender,  and  slightly  enlarged.  The  diphtheritic  patches 
increase  in  area  and  coalesce ;  they  adhere  firmly  to  the  sur- 
face of  the  palate  or  tonsil,  and  when  removed  a  shallow  ulcer 
remains,  leaving  a  bleeding  surface.  The  tongue  is  coated, 
the  breath  fetid,  and  at  times  pieces  of  blood-stained  mem- 
brane are  coughed  up.  The  urine  contains  albumen  and  occa- 
sionally hyaline  and  epithelial  casts.  The  pulse  is  frequent, 
weak,  and  easily  compressed.  Opening  the  jaws  causes  con- 
siderable pain. 

What  is  the  duration  ? 

Uncomplicated  cases  from  four  to  twelve  days. 

What  are  the  complications  ? 

Albuminuria  and  paralysis. 

What  is  the  diagnosis  ? 

From  croup,  inflammation  sthenic  ;  inflammation  commences 
in  the  larynx  and  extends  to  the  trachea  and  bronchi  ;  breath 
not  fetid,  no  swelling  of  the  glands  of  the  neck. 

From  pharyngitis,  absence  of  exudation,  enlargement  of  the 
lymphatic  glands,  and  constitutional  symptoms. 

From  scarlet  fever  by  the  eruption  and  absence  of  mem- 
brane in  the  pharynx,  strawberry  tongue,  and  late  albuminuria. 

What  is  the  prognosis  ? 
Usually  grave. 


94  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  treatment? 

The  diet  should  be  nutritious,  such  as  animal  broths,  milk, 
eggs,  etc.  If  the  child  is  unable  to  swallow,  a  nutritious  ene- 
ma may  be  employed.  Alcoholic  stimulants  should  be  given 
in  moderate  doses  every  hour  if  necessary.  The  throat  should 
be  wrapped  in  flannel  moistened  in  equal  parts  of  turpentine 
and  olive  oil.  Internally  the  tincture  of  the  chloride  of  iron 
combined  with  the  chlorate  of  potassium  should  be  given  every 
two  hours. 

I^.     Potass.  Chlorat.  gr.  xxiv. 
Tr.  Ferri  Chlor.  nxxlviij. 
Glycerinse  f^ss. 
Aquae  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  two  years. 

Quinine  should  be  given  either  by  the  mouth  or  rectum. 

^.     Quinise  Sulphat.  gr.  xij. 
Potass.  Chlorat.  gr.  xlviij. 
Tr.  Ferri  Chlor.  f5j. 
Syr.  Zingiber,  f^j. 
Aquae  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  in  water  every  two  hours  for  a  child  of  six  to  ten 
years.  {Goodhart  and  Starr.) 

:^.     Potass.  Chlorat.  f5ss. 
Acid.  Muriat.  dil.   TJlxvj. 
Tr.  Cinchonse  Comp.  f  ^ss. 
Mellis  f§,j. 

Spt.  Vini  Gal.  f^ss.— M. 
Sig.  Teaspoonful  in  water  every  two  or  three  hours  for  a  child  of 
six  years. 

Calomel  and  sodium  bicarbonate  may  be  given  in  small 
doses  until  the  effect  of  the  calomel  is  noticed  on  the  breath. 

;^.     Hydrarg.  Chlor.  Mit.  gr.  j. 
Sodii  Bicarb,  gr.  xxiv. 
Pulv.  Aromat.  gr.  vj. 
M.  et  ft.  chart.  No.  xii. 
Sig.  Ond  powder  every  two  hours. 


ACUTE    INFECTIOUS    DISEASES.  95 

Any  of  the  following  lotions  will  be  found  useful  locally. 

^.     Potass.  Chlorat.  5j. 
Listerine  §ss. 
Aquse  q.  s.  ad  f  §iv. — M. 
Sig.  Use  as  gargle  every  two  hours. 

I^.     Tr.  Ferri  Chlor.  fSJ.-fSiiJ- 
Glycerinse  q.  s.  ad  i§j.— M. 
Sig.  Paint  tonsils  every  four  hours. 

The  following  is  one  of  the  best  solvents  of  the  membrane  : 

I^.     Trypsin  (Fairchilds's)  5j. 
Sodii  Bicarb,  gr.  xx. 
Aquffi  q.  s.  ad  f^ij. — M. 
Sig.  Apply  with  atomizer  every  hour  at  first  if  necessary. 

Limewater  used  as  a  spray  is  a  very  serviceable  remedy. 

Nasal  diphtheria  should  be  treated  by  syringing  out  the  nasal 
cavities  with  Listerine  and  water,  equal  parts,  and  insufflations 
of  boric  acid  several  times  in  the  twenty-four  hours. 

R.     Acid.  Boric.  55s. 
Sodii  Borat.  5^3. 
Sodii  Chlor.  gr.  xx. 
Aqnse  Oss. — M. 
Si*'.  Inject  5j  warm  in  each  nostril  every  two  hours. 

It  is  well  to  keep  the  air  of  the  room  moist  by  having  a 
kettle  of  water  constantly  boiling. 

If  these  measures  fail  and  the  child  is  in  danger  of  suffoca- 
tintr,  tracheotomy  or  intubation  should  at  once  be  resorted  to. 
For  diphtheritic  paralysis,  iron  and  strychnia  should  be  used 
in  combination  with  electricity. 

During  convalescence  much  care  must  be  taken  to  prevent 
a  sot-back.  The  food  should  be  liberal,  and  the  child  well 
tonicked. 


96  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Varicella. 

What  are  the  synonyms  ? 

Chicken-pox ;  swine-pox. 

What  is  the  definition  ? 

A  contagious  disease,  characterized  by  slight  fever,  and  a 
vesicular  eruption  appearing  the  second  day. 

What  is  the  cause  ? 

A  peculiar  poison  ;  attacks  children  only.  Incubation  from 
eight  to  sixteen  days. 

What  are  the  symptoms  ? 

Slight  fever,  loss  of  appetite,  thirst,  anorexia,  and  constipa- 
tion ;  the  eruption  appearing  after  twenty -four  hours'  illness. 
The  eruption  is  vesicular  and  rapidly  dries  and  drops  off  within 
a  week,  leaving  a  slight  scar  or  pit.  Fortunately  the  eruption 
usually  appears  on  the  body  and  seldom  the  face. 

What  is  the  prognosis  ? 

Always  favorable. 

What  is  the  treatment? 

Seldom  requires  any ;  a  simple  laxative  may  be  given  at  the 
onset,  and  the  child  kept  in  an  evenly-heated  room.  A  little 
vaseline  or  cold  cream  with  glycerine  may  be  smeared  over  the 
body,  to  relieve  the  local  irritation. 

Variola. 

What  is  the  synonym  ? 

Smallpox. 

What  is  the  definition  ? 

An  acute  epidemic  contagious  disease,  characterized  by  an 
acute  febrile  onset,  followed  by  an  eruption  on  the  third  day, 
first  papular,  afterwards  vesicular  and  pustular. 


ACUTE    INFECTIOUS    DISEASES.  97 

What  are  the  causes  ? 

A  specific  poison  the  nature  of  which  is  unknown.  The 
disease  is  contagious  from  the  initial  fever  to  the  end  of  des- 
quamation. One  attack  generally  protects  from  a  second. 
Incubation  fourteen  to  sixteen  days.  Vaccination  almost  a 
positive  protective. 

What  are  the  varieties  ? 

Discrete,  confluent,  malignant,  and  modified. 

What  are  the  symptoms  ? 

Often  ushered  in  by  a  convulsion,  followed  by  a  chill,  fever, 
coated  tongue,  nausea  and  vomiting.  Severe  frontal  headache, 
and  pain  in  back.  Injection  of  the  vascular  system  of  the 
head  and  eyes.  Pain,  due  to  congestion,  in  the  throat  and 
larj'nx,  which  are  red  and  swollen.  Ulcers  in  mouth  and 
fauces ;  restlessness,  dullness,  and  delirium.  This  stage  may 
last  two  days,  and  the  eruption  appears  the  third,  when  all  the 
symptoms  abate.  Small,  hard  red  papules  appear,  slightly 
raised,  occurring  in  groups  of  from  three  to  five  giving  the 
eruption  somewhat  of  a  crescentic  form.  They  are  most  abun- 
dant first  on  the  face,  lips,  forehead,  then  on  neck,  wrist,  body, 
and  extremities.  On  the  third  day  of  the  eruption  vesicles 
form  on  each  papule,  being  at  first  pointed,  then  flattened,  then 
umbilicated ;  reaching  their  full  size  in  three  or  four  days,  be- 
coming harder  and  surrounded  by  a  red  margin,  merging  into 
pustules.  On  the  eighth  or  nintli  day  of  the  eruption  it  is  at 
its  height,  pustules  having  formed.  At  the  height  of  the  erup- 
tion secondary  fever  occurs.  The  most  dangerous  stage,  namely 
that  of  suppuration,  occurs  from  the  ninth  to  the  fourteenth 
day. 

The  temperature  of  smallpox  seldom  goes  above  ]05°  F. 

It  usually  reaches  104°  F.  on  the  second  day,  but  falls  to 

100*^  F.,  when  the  eruption  appears,  only  to  rise  again  during 

the  secondary  fever.     Dessication  or  drying  begins  on  the  face 

7 


98  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

from  the  twelfth  to  the  fourteenth  day,  and  follows  the  course 
of  the  eruption  reaching  the  extremities  last. 

What  are  the  complications  ? 

Suppurating  glands,  erysipelas  ;  deafness  from  suppuration 
of  the  internal  ear ;  pleurisy.  In  the  modified  disease,  namely 
varioloid,  these  never  occur. 

What  is  the  diagnosis? 

Chills,  vomiting,  pain  in  the  back,  headache,  high  fever,  fre- 
quent pulse,  all  subsiding  on  the  third  day,  when  the  eruption 
appears  in  the  following  order  :  spots,  papules,  vesicles  and  pus- 
tules, with  marked  secondary  fever. 

What  is  the  prognosis  ? 

Always  grave  except  in  the  modified,  ^.  e.,  varioloid. 

What  is  the  treatment  ? 

The  child  must  be  kept  in  a  large  well-ventilated  room. 
The  diet  should  be  liquid  and  gentle  laxatives  given.  Cool 
drinks  should  be  administered,  such  as  nitre,  lemonade,  or  the 
solution  of  citrate  of  potassium  may  be  given  in  teaspoonful 
doses  every  hour  or  two.  It  is  important  that  disinfectants 
should  be  distributed  about  the  house,  especially  in  the  passage 
leading  to  the  sick-room.  For  the  initial  fever  the  following 
will  be  found  useful : — 

^..     Tr.  Aconite  Rad.  gtt.  iv-viij. 
Liq.  Potass.  Citrat.  f  ^j. — M. 
Sig.  Teaspoonful  every  twenty  minutes  until  four  doses  are  taken 
for  children  from  three  to  eight  years. 

Should  there  be  much  cerebral  congestion  the  hair  must  be 
cut  and  an  ice  bag  applied  to  the  scalp.  For  sleeplessness  the 
following  may  be  given  : — 

^..     Potass.  Brom.  5iss-5iij' 
Elix.  Aromat.  f^iij. — M. 
Sig.  Teaspoonful  as  required  for  children  from  three  to  eight  years. 


ACUTE    INFECTIOUS    DISEASES.  99 

When  the  secondary  fever  appears  quinine  may  be  given  by 
the  mouth  or  rectum  in  appropriate  doses.  Carbonate  of 
ammonium  and  whiskey  should  be  employed  if  the  typhoid 
condition  sets  in.  Cracked  ice  may  be  held  in  the  mouth, 
and  the  mouth  frequently  washed  with  the  following  solution : — 

B.     Acid.  Boric.  5iss. 
Grlycerinse  f§j. 
Lister  in  e  f|ij. 
Aquae  q.  s.  ad  f^vj. — M. 
Sig.  Mouth-wash. 

The  throat  symptoms  may  be  treated  with  a  mild  gargle  if 
the  child  be  old  enough,  such  as  chlorate  of  potassium  and 
water  (3  to  Oss).  Tincture  of  the  chloride  of  iron  may  be 
given  with  good  results.  The  complications  must  be  treated 
as  they  arise  by  appropriate  measures.  To  prevent  pitting 
the  following  methods  are  recommended  : — 

R.     Ungt.  Hydrarg., 

Ungt.  Aquae  Rosae  aa  5ij« — M. 
Sig.  Applj  on  mask  night  and  morning. 

Tlie  following  ointment  is  used  in  the  Children's  Hospital, 
at  Paris : — 

I^,     Mercurial  Ointment  24  parts. 
Yellow  Wax  10  parts. 
Black  Pitch  6  parts. — M. 
Sig.  Apply  on  mask  night  and  morning. 

A  sharp  pointed  stick  of  silver  nitrate  inserted  into  each 
vesicle  after  rupture  is  said  to  prevent  pitting. 

External  applications  of  powdered  starch,  flour,  tepid  water 
and  vinegar  sponged  over  the  body  twice  daily  will  relieve  the 
itching. 

During  convalescence  the  patient's  system  should  be  kept  up 
by  the  use  of  suitable  tonics  and  nourishing  food. 


100  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Vaccinia. 

What  is  the  definition? 

Inoculation  of  bovine  virus  into  the  system.  When  a  child 
is  properly  vaccinated  it  usually  escapes  an  attack  of  small- 
pox. 

When  should  vaccination  be  performed  ? 

If  the  child  be  healthy,  before  the  fourth  month. 

Describe  the  operation. 

The  skin  of  the  arm  or  leg  should  be  made  tense,  and  the 
surface  scraped  with  the  vaccine  point  containing  the  lymph 
until  the  true  skin  is  reached,  then  the  lymph  should  be  rubbed 
in  and  allowed  to  dry  before  being  covered  by  the  wearing 
apparel. 

What  are  the  symptoms  ? 

If  the  vaccination  is  successful,  constitutional  symptoms 
rarely  appear  before  the  eighth  day.  The  child  becomes 
fretful,  with  slight  fever,  restlessness,  and  slight  anorexia. 

What  is  the  course  of  the  sore  ? 

About  the  third  day  a  small. light-red  nodule  appears  at  the 
seat  of  vaccination  ;  a  vesicle  is  formed  which  begins  to  be  de- 
pressed in  the  centre  on  the  sixth  day,  and  surrounded  by  a 
narrow  ring  of  inflammation ;  this  increases  in  size  and  reaches 
its  height  by  the  eighth  or  ninth  day ;  it  then  becomes  elevated 
above  the  surrounding  surface,  is  of  a  dull  white  color,  and 
about  one-third  of  an  inch  in  diameter.  The  inflammatory 
zone  has  now  become  a  broad  areola  from  one  to  two  inches  in 
breadth,  varying  from  a  rose  to  a  dark  red  color,  gradually 
fading  from  the  centre  to  the  periphery,  where  it  shades  into 
that  of  the  normal  skin.  The  surrounding  tissues  become  in- 
filtrated, hard,  and  tender,  and  reach  their  height  about  the 
tenth  day.     Now  the  areola  rapidly  fades,  and  the  vesicle  loses 


ACUTE    INFECTIOUS    DISEASES.  101 

the  pearly  appearance — pus  taking  the  place  of  lymph  and 
giving  its  characteristic  color  to  the  sore.  By  the  fourteenth 
day  all  inflammation  has  subsided,  and  a  crust  begins  to  form, 
which  becomes  harder  and  darker  in  color,  and  falls  by  the 
end  of  the  third  week.  The  scar  left  is  of  a  deep  red  or  pur- 
plish color,  but  in  the  course  of  a  few  months  to  a  year  becomes 
smaller  in  diameter,  presenting  a  smooth  shining  surface  with 
slight  pin-point  depressions. 

Parotitis. 

What  is  the  synonym? 
Mumps. 

What  is  the  definition  ? 

An  acute,  contagious,  specific  inflammation  of  one  or  both 
parotid  glands,  occurring  but  once  in  a  lifetime,  and  usually 
in  children  over  the  age  of  five  years. 

What  are  the  causes  ? 

A  specific  poison;  contagion.  Occurs  in  epidemics.  More 
prone  to  attack  males  than  females. 

What  are  the  symptoms? 

Chill,  fever,  quick  pulse ;  then  pain  is  felt  and  swelling  is 
noticed  about  the  angle  of  the  jaw,  which  is  exceedingly  hard 
and  painful,  and  may  extend  from  beneath  the  ear  along  the 
neck  to  the  chin.  There  is  pain  in  mastication,  articulation, 
and  swallowing.  It  usually  reaches  its  height  in  three  or  four 
days  and  then  declines  in  severity,  and  gradually  disappears, 
provided  metastasis  does  not  occur,  which  may  be  either  to  the 
brain,  mammae,  or  testis,  when  the  latter  parts  become  painful 
and  swollen.     Suppuration  rarely  occurs  in  this  disease. 

What  is  the  diagnosis? 

Almost  impossible  to  mistake. 


102  ESSENTIALS    OP    DISEASES    OF    CHILDREN. 

What  is  the  prognosis? 

In  uncomplicated  cases  favorable ;  metastasis  to  the  brain 
always  fatal. 

What  is  the  treatment  ? 

The  child  must  be  kept  in  one  room  and  given  a  light  diet. 
Hot  fomentations  should  be  applied  to  the  neck  and  frequently 
changed.  The  bowels  must  be  opened  by  laxatives.  If  the  fever 
is  high  a  course  of  aconite  may  be  given,  from  one-half  to  one 
drop  every  twenty  minutes  until  four  doses  are  taken.  Should 
suppuration  occur,  which  is  very  rare,  the  iodide  of  potassium 
may  be  used.  If  orchitis  appears,  hot  fomentations  should 
be  applied  and  the  child  at  once  put  to  bed.  After  the  swelling 
has  subsided  the  child  should  remain  indoors  for  at  least  two 
weeks. 

Pertussis. 

What  is  the  synonym  ? 
W  hooping-cough . 

What  is  the  definition  ? 

A  specific,  contagious  disease,  characterized  by  a  hard, 
paroxysmal  cough  ;  a  number  of  expiratory  efforts  being  fol- 
lowed by  a  long,  noisy  inspiration  or  whoop. 

What  are  the  causes? 

Occurs  generally  in  children  and  is  contagious ;  the  result  of 
an  unknown  poison ;  one  attack  usually  guards  against  another. 

What  are  the  symptoms  ? 

They  are  divided  into  three  stages,  namely  the  catarrhal, 
spasmodic,  and  terminal. 

The  catarrhal  stage  generally  lasts  from  three  to  ten  days. 
It  is  accompanied  by  coryza,  a  slight  cough,  the  child  is  rest- 
less and  fretful,  with  great  nervous  excitability,  and  sometimes 
delirium  at  night. 


ACUTE    INFECTIOUS    DISEASES.  103 

In  the  spasmodic  stage  the  cough  is  paroxysmal,  the  expira- 
tory eiForts  may  be  so  strained  as  to  cause  the  child's  face  to 
become  cyanosed,  the  veins  of  the  head  and  neck  swollen,  the 
nose  bleeding,  and  occasionally  the  contents  of  the  bladder  and 
rectum  are  involuntarily  discharged.  The  paroxysms,  which 
usually  occur  at  night,  last  from  one-half  to  two  minutes,  re- 
turning at  regular  intervals ;  they  may  be  brought  on  by  over- 
eating, by  taking  any  food,  or  by  cold.  All  spasmodic  attacks, 
except  hysterical  ones,  are  apt  to  occur  at  night.  If  the  par- 
oxysms are  not  too  severe  the  child  will  return  to  its  play,  or 
it  may  become  exhausted  and  gradually  grow  weaker. 

In  the  terminal  stage  or  stage  of  decline  the  paroxysms 
gradually  become  less  severe  and  at  longer  intervals,  the 
cough  becomes  loose,  and  expectoration  freer. 

What  are  the  complications  ? 

Pneumonia,  capillary  bronchitis,  emphysema,  pleurisy,  men- 
ingitis, deafness,  etc. 

What  is  the  diagnosis? 

The  disease  can  only  be  detected  when   the  characteristic 

"  whoop"  is  heard. 

What  is  the  prognosis? 

Quite  serious  in  children  under  six  months ;  more  favorable 

as  age  progresses. 

What  is  the  treatment? 

During  the  catarrhal  stage  a  simple  expectorant,  as  the  fol- 
lowing, should  be  given  : — 

I^.     Tr.  Opii  Camp., 

Syr.  Ipecac.  aaf5J- 
Syr.  Scillae  f  5iij- 
Syr.  Tolu  f  ^ss. 

Liq.  Potass.  Citrat.  q.  s.  ad  f  fiij. — M. 
Sig.  Teaspoonful  overy  two  or  three  houra  for  a  child  of  one  year. 


104  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

The  strength  should  be  kept  up  with  nourishing  food  and 
small  doses  of  quinine  to  prepare  the  system  for  the  spasmodic 
stage. 

It  is  well  at  the  beginning  to  give  an  occasional  emetic,  as 
it  clears  the  bronchial  tubes  of  their  contained  mucus  and 
allows  the  lungs  free  play. 

In  this  stage  the  most  valuable  drugs  are  belladonna,  alum, 
antipyrine,  inhalations  of  sulphur,  bromide  of  potassium  and 
ammonium,  quinia  sulphate,  and  chloral. 

Any  of  the  following  formulae  will  be  found  suitable : — 

R.     Ex.  Belladonnse  gr.  |. 
Pulv.  Aluminis  gr.  xxiv. 
Syr.  Zingiber., 
Aquse  aa  f  ^iss. — M. 
Sig.  One  teaspoonful  every  two  hours  for  a  child  of  one  year. 

(  Goodhart  and  Starr. ) 

Antipyrine  may  be  given  to  children  in  doses  of  from  one- 
quarter  of  a  grain  to  three  or  five  grains,  according  to  age.  It 
is  best  administered  in  the  form  of  a  powder,  in  sweetened  water. 
The  plan  to  be  carried  out  for  sulphur  inhalation  is  as  follows: — 

Have  the  patient's  clothing  changed  and  removed  from  the 
sick-room  in  the  morning.  All  the  clothes  and  the  toys  to  be 
subsequently  used  are  brought  into  this  room,  and  then  sulphur 
is  burnt  upon  live  coals  in  the  centre  of  the  apartment.  In  the 
eveninof  the  child  is  brought  back. 

Monti's  treatment  by  nasal  insufflation  is  very  efficient. 
Two  or  three  grains  of  powdered  benzoin  or  boric  acid  are 
blown  up  the  nose  by  an  insufflator  every  three  hours  during 
the  day  and  once  or  twice  at  night. 

I^.     Ammon.  Brom., 

Potass.  Brom.  aa  5j' 
Tr.  Belladonnse  f5j« 
Grlycerinse  f§j. 

Aquse  Rosse  q.  s.  ad  f  §iv. — M. 
Sig.  Use  as  spray  from  four  to  six  times  daily.  {Keating.) 


ACUTE    INFECTIOUS    DISEASES.  105 

The  diet  and  regimen  of  the  patient  should  be  carefully  regu- 
lated, flannel  should  always  be  worn  next  to  the  skin,  and  the 
child  kept  out  of  doors,  weather  permitting,  as  much  as  pos- 
sible. 

Typhoid  Fever. 

What  are  the  synonyms? 

Enteric  fever  ;  nervous  fever  ;  abdominal  typhus ;  infantile 
remittent. 

What  is  the  definition? 

An  acute,  specillc  disease,  infectious  and  contagious,  associ- 
ated with  a  peculiar  eruption  on  the  skin,  and  disease  of  the 
solitary  and  agrainated  glands  of  the  intestines.  The  period 
of  incubation  is  from  two  days  to  three  weeks. 

What  are  the  predisposing  causes  ? 

Seldom  occurs  in  children  under  the  age  of  five  years ;  most 
frequent  in  autumn  ;  least  so  in  spring. 

What  are  the  exciting  causes  ? 

The  typhoid  germ  (the  bacillus  typhosus).  Lead  pipes  car- 
rying decomposing  matter  are  apt  to  corrode  and  permit  the 
escape  of  gases.  Water  and  milk  may  carry  the  poison  into 
the  system.  Fermentation  of  water  and  stagnation  of  effluvia 
are  the  most  favorable  conditions  for  its  development.  The 
germ  may  be  destroyed  by  disinfecting  the  stools  with  a  solu- 
tion of  the  bichloride  of  mercury  and  the  sputum  by  heat. 

What  is  the  morbid  anatomy  ? 

The  ulceration  of  the  Peyer's  patches  and  of  the  solitary 
gland  is  less  frequent  and  less  extensive  than  found  in  tlie 
adult.  Many  cases  have  no  ulceration  of  any  kind  ;  in  others 
one  or  two  small  ulcers  in  parts  of  the  agminated  glands.  As 
in  adults  the  large  intestine  may  be  the  chief  seat  of  ulceration. 
Dr.  Goodhart  has  in  one  case  seen  death  from  the  after-result 


106  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

of  hemorrhage  from  typhoid  ulceration  of  the  colon.  The 
spleen  is  commonly  found  enlarged,  and  its  structure  is  softer 
and  more  friable  than  is  natural.  The  liver  is  enlarged  and 
often  softened. 

"What  are  the  symptoms? 

The  disease  is  usually  milder  in  children  than  in  adults. 
The  child  will  complain  of  headache  and  lie  about  the  room, 
fretting  and  refusing  to  play ;  loss  of  appetite  and  sometimes 
vomiting,  accompanied  by  slight  fever,  quick  pulse,  and  dry 
skin,  are  noticed  during  the  day.  At  night  the  face  becomes 
flushed,  the  lips  red,  and  the  tongue  dry ;  the  sleep  is  restless 
and  frequently  disturbed  by  delirium.  The  symptoms  all  sub- 
side on  the  following  morning  to  appear  again  at  night.  Day 
after  day  these  symptoms  continue,  and  now  the  abdomen  is 
tumid,  the  spleen  enlarged ;  diarrhcea  is  present  and  rose  spots 
may  appear ;  there  is  considerable  cough,  and  the  child  rap- 
idly becomes  emaciated.  The  evacuations  from  the  bowel 
are  often  ochrey  and  pasty  in  character,  having  a  very  offen- 
sive smell.  The  tongue  is  dry,  red  at  the  tip,  and  fissured. 
The  urine  is  high-colored  and  scanty.  The  pulse  is  usually 
variable,  rising  or  falling  withoyt  affecting  the  heat  of  the  skin. 
The  temperature  is  usually  characteristic,  that  of  the  morning 
being  a  degree  or  so  less  than  that  of  the  evening. 

From  the  eighth  to  the  twelfth  day  of  the  disease  the  erup- 
tion appears,  which  consists  of  rose-colored  spots,  slightly  ele- 
vated above  the  skin  and  disappearing  on  pressure.  Each 
spot  lasts  from  two  to  five  days,  then  disappears,  while  fresh 
ones  continue  coming  out ;  they  occur  on  the  abdomen,  chest, 
and  back,  and  their  number  may  vary  from  one  or  two  up  to 
forty.  The  more  severe  symptoms  may  now  manifest  them- 
selves, such  as  obstinate  vomiting  and  profuse  diarrhoea,  and 
occasionally  the  opposite  condition,  constipation,  may  exist. 
There  may  be  tenderness  over  the  abdomen  in  the  region  of 


ACUTE    INFECTIOUS    DISEASES.  107 

the  right  iliac  fossa,  where  gurgling  may  be  distinctly  heard. 
The  child  loses  flesh;  the  face  is  worn  and  anxious ;  the  cough 
increases,  with  marked  dyspnoea  and  harshness  of  breathing. 
Epistaxis  and  bleeding  of  the  gums  occasionally  occur. 

The  symptoms  may  either  gradually  improve  in  the  third 
week  or  the  disease  goes  on,  and  may  terminate  in  hemorrhage 
or  perforation  of  the  bowels.  Hemorrhage  rarely  occurs  after 
the  fourth  week,  but  perforation  may  occur  up  to  the  sixth. 
Muscular  tremor;  pulse  of  150  to  the  minute  or  over  are  grave 
signs. 

What  are  the  complications  ? 

Intestinal  hemorrhage  and  perforation  are  uncommon  in 
children.  Meningitis,  pneumonia,  severe  bronchitis,  and  heart 
failure  occasionally  occur. 

What  is  the  diagnosis  ? 

In  mild  cases  among  the  poor  the  disease  may  escape  the 
notice  of  the  parents.  It  should  be  remembered  that  typhoid 
fever  rarely  occurs  before  the  fifth  year,  and  should  not  be  con- 
founded with  the  slight  gastric  disorders  during  dentition. 
The  presence  of  fever,  delirium,  diarrhoea,  and  rose  colored 
spots  with  typhoid  tongue,  will  usually  aid  in  the  diagnosis. 

In  tubercular  peritonitis  the  tongue  is  usually  clean  and 
moist  and  there  is  no  eruption. 

From  acute  tuberculosis  the  diagnosis  is  most  difficult,  and 
is  almost  impossible  during  life,  tliere  being  only  the  absence 
of  the  eruption  and  diarrhoea  to  guide  us. 

What  is  the  prognosis? 
Not  so  grave  as  in  adults. 

What  is  the  treatment  ? 

The  child  must  be  kept  in  bed  in  a  well-ventilated  room. 
The  diet  should  be  entirely  liquid,  such  as  milk,  beef-tea, 
mutton  or  chicken  broth.  Should  these  be  rejected  milk  alone 
with  limewater  may  be  given.     The  urine  and  stools  should 


108  ESSENTIALS    OF    DISEASES    OF    CHILDKEN. 

be  disinfected  and  immediately  removed  from  the  sick-room. 
If  the  case  be  mild,  the  child  will  do  perfectly  well  on  a  few 
drops  of  dilute  muriatic  acid  in  water  three  or  four  times  a  day, 
and  from  one  to  two  grains  of  quinine  at  the  same  intervals. 
In  cases  where  the  symptoms  are  severe  and  the  fever  runs 
hi"fh  stimulants  should  be  administered,  such  as  wine  or 
brandy,  from  two  to  four  ounces  of  the  former  and  from  one  to 
two  ounces  of  the  latter  in  the  twenty-four  hours.  If  constipa- 
tion is  present,  it  should  be  treated  by  a  simple  enemata  or  a 
small  dose  of  castor-oil.  In  more  severe  cases  where  noisy 
delirium  is  present,  small  doses  of  Dover's  powder  or  bromide 
of  potassium  will  be  found  beneficial.  If  the  temperature  re- 
mains over  103°  F.,  tepid  sponging,  cold  sponging,  or  the 
tepid  or  even  cold  bath  will  be  of  service.  Antipyrin  may  be 
given  to  children,  between  six  and  ten  years,  in  doses  of  three 
to  five  grains.  It  lowers  the  temperature  and  usually  produces 
profuse  sweating.  Although  a  valuable  drug  it  may  produce 
severe  depression,  and  even  collapse,  consequently  its  adminis- 
tration should  be  carefully  watched.  The  sulphate  of  thalline 
may  be  used  in  doses  of  one  to  three  grains  as  an  antipyretic. 

For  abdominal  distention,  turpentine  or  terebine  should  be 
given.  Five  drops  of  the  former  or  two  or  three  drops  of  the 
latter  may  be  dropped  upon  a  lump  of  sugar  and  administered. 

For  the  diarrhoea,  five  drops  of  laudanum  in  an  ounce  of 
starch  water  should  be  given  by  enema.  Should  the  diarrhoea 
be  slight,  for  instance,  two  or  three  evacuations  in  the  twenty- 
four  hours,  it  must  not  be  checked.  The  following  prescrip- 
tion will  be  found  useful : — 

^.     Bismuth.  Subnit.  5ilj- 
Spt.  Myristicse  f  5*^8. 
Spt.  Vini  Gal.  f§j. 
Syr.  Acacise  f  ^iss. 
Aquae  Cinnam.  q.  s.  ad  ffiij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  ten  years. 


ACUTE    INFECTIOUS    DISEASES.  109 

Tlie  tliarrlia3a  may  often  be  moderated  by  reducing  the 
quantity  of  milk  and  using  animal  broths  only. 

For  bronchitis  the  followins  will  be  found  useful  : — 

5:.     Tr.  OpiiCamp.  f5iij. 
Syr.  Ipecac.  f5ij. 
Syr.  Tolu  f§ij. 
Aquae  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  every  three  or  four  hours  for  a  child  of  ten  years. 

In  cases  of  cardiac  weakness  Jacobi  prefers  cafFein  to 
digitalis.  It  is  given  in  grain  doses  to  children  of  six  or  seven 
years. 

During  convalescence  the  child  should  be  carefully  watched 
over  and  not  allowed  to  eat  solid  food  until  all  symptoms  have 
disappeared,  and  then  ©nly  by  the  advice  of  the  physician. 


110  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

PART   VII. 

General  Diseases  not  Infectious. 
Malarial  Fever. 

What  are  the  synonyms  ? 

Ague  ;  intermittent  fever;  chills  and  fever. 

What  is  the  definition  ? 

A  paroxysmal  fever,  characterized  by  a  cold,  hot,  and  a  sweat- 
ing stage,  not  followed  by  an  interval  of  complete  intermission 
or  apyrexia  as  in  adults,  the  child  being  feverish  and  restless 
between  the  spells. 

What  are  the  causes  ? 

Malaria ;  conditions  such  as  exposure  to  cold,  over-eating 
or  drinking,  violent  exercise,  etc.,  are  supposed  to  encourage  it. 

What  is  the  pathological  anatomy  ? 

Blood  dark  ;  liver  and  spleen  enlarged. 

What  are  the  sjnnptoms  ? 

The  cold  stage  is  ushered  in  with  chilliness,  shivering,  blue- 
ness  of  lips,  thirst,  anxiety,  hurried  respiration,  and  weak  pulse. 
The  child  is  weak,  restless,  dull,  and  heavy.  This  stage  is 
very  imperfectly  marked  in  children. 

This  is  followed  by  the  hot  stage,  in  which  the  skin  becomes 
hot  and  dry;  the  temperature  rises  from  104°  to  105°  F., 
which  is  usually  present  during  the  cold  stage  to  106°  to  107° 
F.  Now  the  patient  feels  hot  and  throws  the  bed-clothes  off, 
the  skin  becomes  red  and  swollen,  and  there  is  thirst,  severe 
headache,  and  sometimes  vomiting ;  the  pulse  is  quick  and 
hard  ;  respiration  more  regular.  The  last  stage,  sweating,  is 
very  short  in  children,  and  sometimes  altogether  absent.  The 
splenic  enlargement  is  well  marked  in  children,  and  is  apt  to 
be  more  permanent  than  in  adults. 


GENERAL    DISEASES    NOT    INFECTIOUS.  Ill 

What  is  the  diagnosis  ? 

Not  difficult  when  the  chill,  fever,  and  sweat  occur. 

What  is  the  prognosis  ? 

Difficult  to  eradicate.  The  enlargement  of  the  spleen  may 
be  slow  to  disappear. 

What  is  the  treatment  t 

Quinine  and  arsenic  are  the  best  drugs  to  employ.  Quinine 
may  be  given  in  syrup  of  licorice  or  syrup  of  ginger,  or  the 
officinal  quinine  chocolates  may  be  employed.  Arsenic  should 
be  given  in  the  form  of  Fowler's  solution,  in  doses  of  from 
three  to  five  drops  in  water,  to  be  gradually  increased  three 
times  a  day.  It  may  also  be  combined  with  iron  and  ad- 
ministered with  the  syrup  of  the  lacto-phosphate  of  lime. 

Rickets. 

What  is  the  synonym  ? 

Rachitis. 

What  is  the  definition  ? 

A  constitutional  disease  of  childhood,  characterized  by 
general  cachexia,  a  peculiar  condition  of  the  bones,  and  often 
by  albuminoid  degeneration  of  some  portion  of  the  glandular 
system. 

What  are  the  causes  ? 

It  is  rarely  congenital,  and  probably  not  hereditary,  although 
the  children  of  drunken,  syphilitic,  and  scrofulous  parents  are 
more  liable  to  develop  it.  The  most  frequent  causes  are  im- 
proper feeding ;  a  child  nursed  at  a  breast  of  a  pregnant 
woman  ;  bad  air ;  ill-ventilated  rooms  ;  overcrowding  ;  im- 
proper clothing  ;  want  of  cleanliness,  etc. 

At  what  age  does  it  usually  occur  ? 

From  ten  months  to  two-and-a-half  years. 


112  ESSENTIALS    OF    DISEASES    OF    CniLDKEN. 

What  are  the  symptoms  ? 

Somewhat  vague  in  the  earlier  stages  of  the  disease.  Diar- 
rhoea, restlessness,  a  tendency  to  throw  off  the  bed-clothes ; 
sweating  of  the  head,  neck,  and  chest ;  crying  when  being  car- 
ried or  even  moved  by  the  attendant,  and  a  flabby  condition  of 
the  muscles  of  the  arms  and  legs  are  the  symptoms  which  are 
first  observed ;  later,  the  ribs  become  beaded,  the  wrists,  knees, 
and  ankles  enlarge,  and  the  shape  of  the  head  becomes  charac- 
teristic. In  the  latest  stage  the  child  is  emaciated,  the  ribs 
fall  in,  the  long  bones  and  spine  curve,  the  liver  and  spleen 
become  enlarged,  and  death  may  occur  from  bronchitis,  pneu- 
monia, or  convulsions.  The  teeth  of  rickety  children  are 
always  backward  ;  when  cut,  soon  decay  or  drop  out. 

The  head  in  rickets  is  characteristic ;  the  veins  of  the  fore- 
head are  well  filled  with  blood  and  stand  out ;  the  fontanelle  is 
open  and  bulging ;  the  head  appears  flattened  in  the  temporal 
region,  and  is  elongated  from  back  to  front.  The  forehead  is 
overhanging  and  square,  giving  the  face  a  small  or  pinched 
look. 

The  abdomen  is  always  enlarged,  also  the  liver  and  spleen. 
There  is  great  loss  of  muscular  power,  the  perspiration  in- 
creases, the  stools  become  very  offensive,  the  appetite  cap- 
ricious, and  if  improvement  does  not  take  place  by  treatment 
the  cliild  sinks  from  exhaustion  or  some  thoracic  or  abdominal 
complication,  such  as  bronchitis,  albuminoid  infiltration  of  the 
spleen  or  lymphatic  glands. 

What  is  the  morbid  anatomy  ? 

When  a  section  is  made  lengthwise  through  the  epiphyseal 
end  of  a  rickety  bone  and  its  adjacent  cartilage,  moderately 
healthy  bone  is  seen  on  the  one  side,  healthy  cartilage  on  the 
other,  and  between  the  two  a  layer  of  bluish  or  pearl-gray 
or  translucent  cartilage.  The  margin  of  this  toward  the  car- 
tilage is  regular,  but  streaked  with  large  vascular  lines  ;  toward 


GENERAL    DISEASES    NOT    INFECTIOUS.  113 

the  bone  it  is  irregular.  The  adjacent  layer  of  bone  is  seen  to 
be  paler  or  yellower  than  normal,  and  more  porous. 

The  pearly  layer  of  swollen  cartilage  causes  the  enlargement 
of  the  ends  of  the  long  bones. 

Microscopically,  excessive  activity  of  the  cartilage  is  ob- 
served ;  the  cartilage  cells  become  swollen  and  largely  in- 
creased in  number ;  but  instead  of  making  good  bone,  a 
process  of  calcification  goes  on  in  them,  and  the  interstices 
between  them  become  filled  with  a  vascular  marrow  instead  of 
natural  bone. 

The  bone  changes  in  rickets  are  excessive  activity  of 
growth  of  that  cartilage  which  makes  bone,  and  the  production 
of  a  large  quantity  of  vascular  embryonic  tissue,  or  medulla. 

The  lymphatic  glands  probably  undergo  some  change  of  a 
fibroid  nature.  The  actual  change  in  the  viscera  is  an  increase 
in  the  fibroid  material,  which  constitutes  the  connective  tissue 
of  the  organs,  and  it  differs  in  no  respect  from  that  of  the 
chronic  enlargement  of  the  viscera,  met  with  sometimes  in 
ague,  etc. 

What  is  the  diagnosis  ? 

Sweating  of  the  head ;  the  general  soreness  and  tenderness 
of  the  body  when  the  child  is  moved.  Retarded  dentition  will 
often  point  to  the  disease  before  the  bones  begin  to  change. 

What  is  the  prognosis  ? 

If  discovered  in  time,  and  the  child  has  good  hygienic  sur- 
roundings, the  prognosis  is  favorable. 

What  is  the  treatment? 

The  child  must  be  given  proper  food,  and  kept  in  a  pure 
atmosphere  ;  a  tepid  bath  should  be  given  night  and  morning, 
followed  by  brisk  rubbing  of  the  entire  body,  should  the  child 
be  able  to  stand  it;  the  clothing  must  be  well  aired  and  kept 
perfectly  clean  ;  plenty  of  out-door  exercise  should  be  given, 
weather  permitting. 
8" 


114  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

As  regards  medical  treatment,  cod-liver  oil  and  iron  are  t'le 
sheet  anchors  ;  the  former  may  be  given  in  doses  of  from  twenty 
drops  to  a  drachm,  three  times  a  day,  plain  or  in  the  form  of 
an  emulsion.  The  best  form  of  iron  to  be  employed  is  the 
syrup  of  the  iodide,  which  may  be  given  in  doses  of  from  three 
to  five  or  even  ten  drops,  in  some  preparation  of  malt ;  the 
syrup  of  the  lacto- phosphate  of  lime  and  iron  is  also  a  valuable 
remedy,  and  may  be  given  in  half-drachm  or  drachm  doses, 
well  diluted.  Any  of  the  following  formulae  may  be  found 
useful : — 

^.     Syr.  Ferri  lodid.  f5j. 
Syr.  Zingiber,   f  §j. 
Aquae  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  three  times  a  day  for  a  child  of  two  years. 

^.     Syr.  Ferri  lodid.  f  5iss. 
Mist.  01.  Morrhuse  et  Lacto- phos.  Calcis  q.  s.  ad  f  fiij. — M. 
Sig.  From  one-half  to  one  teaspoonful  three  times  a  day. 

The  diarrhoea  of  rickets  may  first  be  treated  by  administer- 
ing a  teaspoonful  of  castor  oil  to  clear  out  the  intestinal  canal, 
then  the  diet  should  be  carefully  regulated,  and  all  starchy 
food  prohibited  ;  if  relief  is  not  obtained  chalk  mixture  with 
bismuth  may  be  employed,  such  as  is  prescribed  under  Simple 
Diarrhoea.  The  bronchitis  should  never  be  overlooked  beings 
of  much  importance  in  these  cases.  The  child  should  be  kept 
in  a  warm  room,  poultices  applied  to  the  chest,  the  bowels  kept 
freely  opened,  and  the  muriate  or  carbonate  of  ammonia  given 
in  a  mixture  containing  the  syrup  of  ipecacuanha : — 

^.     Ammon.  Chlor.  gr.  xxiv. 
Syr.  Ipecac.  f5iss. 
Syr.  Tolu  f  fj. 

Liq.  Potass.  Citrat.  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  every  two  or  three  hours  for  a  child  of  two  years. 


GENERAL    DISEASES    NOT    INFECTIOUS.  115 

Convulsions  must  be  kept  at  bay  with  bromide  of  potassium 
and  chloral,  the  latter  is  best  given  in  enemata. 

The  deformities  of  the  limbs  are  best  prevented  by  keeping 
the  child  entirely  off  its  legs  until  the  bones  grow  stronger. 

Acute  Rheumatism. 

What  is  the  synonym  ? 

Rheumatic  fever. 

What  is  the  definition? 

An  affection  not  very  common  in  young  children,  character- 
ized by  fever,  inflammation  of  the  joints  and  a  tendency  to  in- 
flammation of  the  endo-  or  pericardium. 

What  are  the  causes  ? 

Early  infancy  is  said  to  protect  to  a  certain  extent ;  more 
common  among  boys  than  girls.  It  may  be  hereditary  or 
complicate  scarlet  fever.  Exposure  to  cold,  chilling  of  the 
body,  dampness.  A  first  attack  is  frequently  followed  by 
others. 

What  are  the  symptoms? 

The  disease  usually  sets  in  with  rigors  and  feverishness,  which 
is  followed  in  a  day  or  two  by  a  swelling  about  the  joints.  Tlie 
fever  may  run  from  101°  to  104°  F.,  the  latter  indicating  a 
grave  attack.  The  tongue  is  heavily  coated,  the  body  is  in  a 
profuse  acid  perspiration  emitting  a  peculiar  odor.  The  quan- 
tity of  urine  is  diminished,  dark  in  color,  and  loaded  with 
lithates.  The  large  joints  are  usually  attacked  first,  and  the 
disease  may  wander  from  ankles  and  knees  to  elbows  and 
wrists,  the  swelling  subsiding  in  one  part  as  another  is  attacked. 
The  affected  joint  is  reddish  in  color,  tender,  and  hot.  Inflam- 
mation of  the  pericardium  occurs  in  a  large  percentage  of 
cases.  It  is  first  noticed  by  a  tight  feeling  and  a  pain  in  the 
chest  which  is  often  so  slight  as  to  be  overlooked.     Friction 


116  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

sound  is  now  audible  over  the  whole  area  of  the  heart's  dulness, 
but  especially  at  the  base.  As  effusion  takes  place,  the  area  of 
dulness  is  increased,  and  the  sounds  of  the  heart  muffled. 

What  are  the  complications  ? 

Pericarditis,  endocarditis,  chorea,  meningitis,  bronchitis, 
pleurisy,  etc. 

What  is  the  duration? 
From  ten  to  thirty  days. 

What  is  the  diagnosis  ? 

Very  simple  after  the  articular  symptoms  have  appeared. 

What  is  the  prognosis  ? 

When  uncomplicated,  scarcely  ever  fatal. 

What  is  the  treatment  ? 

The  child  must  be  put  to  bed,  and  kept  between  blankets. 
The  diet  should  be  light  and  farinaceous.  The  inflamed  joints 
should  be  wrapped  in  flannel  or  cotton  batting,  moistened  with 
either  lead- water  and  laudanum  or  chloroform  liniment.  Inter- 
nally, salicylate  of  sodium  may  be  given  in  doses  of  from  two 
to  ten  grains  every  three  or  four  hours,  according  to  the  age 
of  the  child  : — 

T^.     Sodii  Bicarb.  5U' 
Sodii  Salicylat.  5iss. 
Aquae  Menthse  Pip.   f  ^iij. — M. 
Sig.     Teaspoonful  every  three  or  four  hours. 

The  above  formula  is  very  simple  and  seldom  causes  any 
nausea  as  this  drug  is  apt  to  do  when  given  in  syrup.  The 
soda  should  be  omitted  when  the  urine  becomes  alkaline. 
Another  pleasant  way  of  administering  it  is  in  milk. 

Should  pericarditis  or  acute  endocarditis  be  present  the 
cliest  must  be  covered  with  wool  or  a  poultice,  and  the  dose 
of  the  salicylate  of  sodium  decreased  or  even  suspended  for  a 
time,  and  small  doses  of  opium  in  the  form  of  Dover's  powder 


GENERAL    DISEASES    NOT    INFECTIOUS.  117 

given  three  or  four  times  in  tlie  twenty-four  hours  in  doses  of 
three  or  four  grains  to  a  child  of  six  or  seven  years,  and  bella- 
donna or  digitalis  must  be  given  when  necessary. 

Salol  and  antipyrine  may  be  employed  instead  of  the  salicy- 
late of  sodium,  the  dose  of  the  former  for  a  child  of  six  would 
be  two  or  three  grains  every  four  hours,  and  the  latter  (should 
there  be  no  cardiac  complications),  three  to  five  grains  every 
four  hours. 

Should  the  attack  follow  scarlet  fever  iron  may  be  combined 
in  the  mixture. 

For  the  nervous  condition  more  generally  seen  in  girls  either 
the  bromide  of  potassium  or  sodium  should  be  employed. 

During  convalescence  the  child  should  receive  good  nourish- 
ing food,  a  tonic  containing  quinine  and  nux  vomica  and  a 
change  of  air. 


118  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

PART   VIII. 

The  Diathetic  Diseases. 

Scrofula. 

What  is  the  definition? 

A  morbid  condition,  usually  constitutional,  and  frequently 
hereditary,  characterized  by  glandular  tumors,  having  a  ten- 
dency to  suppurate. 

What  are  the  causes  ? 

May  be  either  constitutional  or  hereditary;  limited  to  child- 
hood, affecting  chiefly  the  lymphatic  glands. 

What  are  the  symptoms? 

A  Strumous  child  usually  has  a  phlegmatic  temperament ; 
the  mind  and  body  are  backward ;  the  child  is  dull  and  heavy. 
The  skin  is  thick  and  of  a  muddy  appearance ;  the  complexion 
doughy,  the  upper  lip  thick,  the  nostrils  wide,  and  the  alae  of 
the  nose  thickened.  The  cervical  glands  are  most  commonly 
affected.  The  abdomen  is  tumid  and  the  ends  of  the  bones 
thickened. 

What  are  the  complications  ? 

Bronchial,  gastric,  and  intestinal  catarrh;  otorrhoea,  ozsena, 
and  strumous  ophthalmia. 

What  is  the  treatment? 

If  there  be  a  history  of  scrofula  in  either  parent,  the  mother 
must,  during  utero-gestation,  wear  warm  clothing,  avoid  excite- 
ment, and  take  regular  out-door  exercise.  She  should  not 
nurse  her  child  but  at  once  procure  a  healthy  wet-nurse. 
When  the  child  is  weaned  much  care  must  be  taken  to  exclude 
improper  food.  At  first,  pure  cow's  milk  should  be  used 
guarded  by  a  small  quantity  of  lime  water ;  later  on  light 
animal  broths,  free  from  fat,   may   be  employed.     The  child 


THE    DIATHETIC    DISEASES.  119 

should  wear  flannel  next  to  the  skin  all  the  year  round,  long 
stockings  and  stout  shoes.  Plenty  of  open  air  exercise  should 
be  encouraged.  A  salt  bath  may  be  given  daily,  followed  by 
vigorous  rubbing  of  the  body  with  a  moderately  coarse  towel 
followed  by  the  hand. 

The  three  principal  drugs  to  be  employed  are  iodine,  iron, 
and  cod-liver  oil.  Five  drops  of  the  syrup  of  the  iodide  of 
iron  may  be  given  in  a  teaspoonful  of  maltine  three  times  a 
day  to  a  child  of  four  years,  gradually  increasing  the  dose  of 
the  former.  Cod-liver  oil  may  be  given  plain  or  with  the 
lacto-phosphate  of  lime  in  the  form  of  an  emulsion.  The 
bowels  should  be  kept  freely  opened  with  some  simple  saline. 
The  enlarged  glands  must  be  painted  with  the  tincture  of 
iodine,  or  icthyol  ointment  may  be  applied.  Should  an  abscess 
occur  it  should  be  opened  at  once,  and  the  general  strength  of 
the  child  supported  during  suppuration. 

Tabes  Mesenterica. 

What  is  the  definition  ? 

A  tubercular  degeneration  of  the  mesenteric  glands,  re- 
sembling chronic  or  tubercular  peritonitis  in  its  symptoms. 

What  are  the  symptoms  ? 

Pain  in  the  abdominal  region  ;  irregularity  of  the  bowels 
with  clay-like  offensive  stools.  The  abdomen  is  large  and 
tumid,  but  the  rest  of  the  body  wastes ;  nightly  temperature 
slightly  elevated. 

As  the  glands  enlarge  pressure  upon  the  neighboring  organs 
is  manifested.  Enlargement  of  the  abdominal  veins  is  com- 
mon. Ascites  is  frequently  present,  due  either  to  pressure 
upon  the  thoracic  duct  or  vena  porta?.  Considerable  tympanites, 
vomiting,  and  diarrhoea  may  be  present. 

Towards  the  close    hectic  fever  sets   in,  the  pulse  becomes 


120  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

rapid,  profuse  sweats  are  very  commoD,  and  the  child  usually 
dies  from  exhaustion,  enteritis,  or  peritonitis. 

What  is  the  diagnosis? 

Can  only  be  positively  made  when  the  enlarged  glands  are 
felt. 

What  is  the  prognosis? 

Usually  grave. 

What  is  the  treatment? 

The  food  should  be  of  the  most  nutritious  kind,  but  always 
given  in  a  small  quantity.  The  juice  expressed  from  raw  beef, 
mutton  or  chicken  broth,  eggs  lightly  boiled,  and  fresh  fish  are 
to  be  employed.  Milk  may  be  given,  if  after  a  trial  it  is  found 
perfectly  digested  in  the  evacuations. 

As  regards  drugs,  the  syrup  of  the  iodide  of  iron  will  be 
found  useful.  Cod-liver  oil  may  be  given  in  small  doses  by 
the  mouth,  but  it  is  preferably  employed  by  inunction.  Chloride 
of  calcium  may  be  given  to  children  three  years  old  in  five 
grain  doses,  and  iodoform  in  a  dose  of  about  half  a  grain.  If 
lumps  are  felt  near  the  surface  a  five  per  cent,  solution  of  the 
oleate  of  mercury  may  be  painted  over  the  abdomen  for  a  few 
days,  and  repeated  at  frequent  intervals.  Should  much  ab- 
dominal pain  be  complained  of,  Dover's  powder  in  two  and 
a  half  grain  doses  may  be  given  to  a  child  of  four  or  five  years 
twice  daily. 

Infantile  Syphilis. 

How  may  infantile  syphilis  be  divided? 

Into  congenital  and  acquired,  the  former  being  derived  from 
the  blood  of  one  or  both  parents,  and  the  latter  by  contact 
with  a  chancre,  as  in  a  wet-nurse  or  any  person  brought  into 
close  connection  with  the  child. 


THE    DIATHETIC    DISEASES.  121 

What  are  the  symptoms  ? 

Children  born  with  syphilis  are  usually  very  small  and  puny- 
looking,  their  cry  is  feeble,  the  skin  scaly  and  copper-colored. 
The  lips  are  generally  thick  and  fissured,  there  is  ulceration, 
condylomata  about  the  anus  and  buttocks,  and  the  soles  of  the 
feet  will  be  found  red  and  scaly.  In  severe  cases  the  entire 
body  is  covered  with  dark,  moist  crusts  or  scales  and  a  few 
scattered  blebs  containinoj  serum. 

In  older  infants  the  fontanelle  will  usually  be  found  open 
and  ossification  slow.  The  teeth  are  cut  early.  The  voice  is 
hoarse  and  squeaking ;  the  nails  are  small ;  the  liver  is  large 
and  hard.  The  posterior  cervical  glands  are  frequently  en- 
larged. The  enlargement  of  the  liver  often  causes  pains  in  the 
belly,  vomiting,  and  frequently  diarrhcea.  The  child's  face 
has  an  old  look  ;  the  hair,  eyebrows,  and  even  eyelashes  may 
have  fallen  out;  the  corners ^f  the  lips  and  nose  are  often 
ulcerated  ;  the  body  is  covered  with  a  raised,  coppery  erup- 
tion. The  nasal  mucous  membrane  is  thick  and  swollen,  and 
the  child  is  constantly  snuffling. 

In  milder  cases  there  may  be  simply  snuffling,  with  a  squamo- 
tubercular  rash,  or  irregular  blotches  of  coppery  roseola. 

What  is  the  morbid  anatomy  ? 

The  liver  is  enlarged,  indurated,  and  round  ;  gummy  tumors 
are  rarely  found  as  in  adults.  The  lungs  may  be  filled  with 
gummy  tumors  and  usually  present  cheesy  degeneration  of 
their  central  portion  ;  consolidation  may  also  be  present,  which 
is  known  as  white  hepatization.  The  spleen  may  be  enlarged, 
dark  colored,  and  hard. 

What  is  the  diagnosis  ? 

During  the  early  symptoms  the  diagnosis  is  easy.  The  dis- 
coloration of  the  skin,  the  eruption  appearing  a  few  weeks  later, 
the  constant  "  snuffles,"  hoarse  cry,  history,  etc.  During  tlie 
later  periods  of  the  disease,  at  or  after  the  age  of  twelve  years, 


122  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

the  diagnosis  is  more  obscure.  Now  much  will  depend  upon  the 
history  and  general  appearance  of  the  child  as  compared  with 
other  children  of  the  same  family.  The  [)resence  of  the  pecu- 
liar alteration  of  the  teeth  described  by  Hutchinson  and  inter- 
stitial keratitis  should  be  looked  for. 

What  is  the  prognosis  ? 

Unfavorable  if  the  disease  appears  soon  after  birth.  If  the 
disease  does  not  manifest  itself  until  the  third  or  fourth  week, 
and  if  the  general  nutrition  is  not  greatly  impaired  and  under 
proper  treatment,  the  prognosis  is  favorable  as  regards  saving 
of  life. 

What  is  the  treatment? 

Every  care  must  be  taken  to  support  the  strength  of  the  child 
by  the  most  nutritious  diet,  provided  it  is  unable  to  suckle  the 
mother.  A  healthy  wet-nurs&  should  not  be  employed,  on 
account  of  the  danger  of  her  being  infected  by  the  child.  As 
to  medicinal  treatment,  mercury  in  some  form  should  always 
be  used.  If  the  child  is  nursed  at  the  breast  the  mercury  may 
be  given  to  the  mother,  although  its  action  is  rather  uncertain. 
Dr.  Eustace  Smith  highly  indorses  the  hydrargyrum  cum  creta 
and  the  liquor  hydrargyri  perchloridi.  The  former  may  be 
given  in  grain  doses  twice  daily,  combined  with  bismuth  or 
bicarbonate  of  sodium,  to  be  increased  to  two  grains  if  neces- 
sary. 

^..     Hydrarg.  C.  Cretse  gr.  xii-xxiv. 
Sodii  Bicarb,  gr.  xxxvj. 
Sacch.  Lact.  gr.  xxiv. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  night  and  morning. 

Should  the  bowels  become  too  loose  the  solution  of  the  per- 
chloride  should  be  given  in  doses  of  from  fifteen  drops  to  half  a 
drachm,  which  may  be  increased  if  necessary. 

Daily  inunctions  of  half  a  drachm  of  mercurial  ointment  may 


THE    DIATHETIC    DISEASES.  123 

be  rubbed  upon  the  abdomen,  back,  and  sides,  protecting  the 
parts  with  a  flannel  binder.  The  child  should  be  carefully 
bathed  each  day  before  the  inunction  is  made. 

Diarrhoea  and  vomiting  must  receive  the  same  treatment  as 
under  other  circumstances. 

Of  the  local  symptoms,  the  enlargement  of  the  liver  fre- 
quently subsides  under  mercurial  treatment ;  that  of  the  spleen 
is  more  troublesome,  and  its  continuance  should  not  warrant 
the  long  administration  of  the  mercury  if  the  other  symptoms 
have  subsided.  In  pneumonia  and  bone  disease  the  drug  must 
be  continued,  and,  in  addition,  stimulants,  such  as  alcohol  or 
carbonate  of  ammonium,  should  be  given  in  the  former,  and 
cod-liver  oil  and  iron  in  the  latter. 

Condylomata  must  be  kept  as  clean  and  dry  as  possible, 
and  dusted  with  calomel  or  equal  parts  of  calomel  and  oxide 
of  zinc  twice  daily.  The  patches  that  appear  at  the  angles  of 
the  mouth  may  be  treated  in  the  same  way.  For  the  sores 
that  form  over  the  trunk  and  extremities  the  ungt.  hydrarg. 
oxid.  rub.  may  be  used.  After  the  more  definite  symptoms 
have  disappeared  the  child  should  be  given  a  prolonged  course 
of  the  iodide  of  potassium  and  cod-liver  oil. 


124  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

PART   IX. 
Diseases  of  the  Spleen  and  Blood. 

How  are  diseases  of  the  spleen  recognized  ? 

By  a  peculiar  pallor  of  the  face  and  enlargement  of  the 
organ. 

What  are  the  causes  ? 

Splenic  enlargement  is  a  common  affection  in  children,  and 
may  be  due  to  one  of  the  following  diseases  :  typhoid  fever, 
rickets,  syphilis,  tubercle,  or  ague.  Increase  in  size  and  alte- 
ration of  structure  are  at  times  found  with  Hodgkins's  disease. 
Splenic  enlargement  is  often  associated  with  cirrhosis  of  the 
liver. 

What  is  the  morbid  antomy  ? 

The  spleen  is  large,  its  capsule  thick,  its  substance  firm, 
pale,  or  dark  colored.  Microscopically  the  fibrous  septa  of 
the  organ  are  thickened.  The  tubercular  spleen  has  scattered 
over  the  surface  of  its  capsule  many  gray,  miliary  tubercles, 
and  similar  bodies  may  be  found  through  its  substance. 

What  are  the  symptoms  ? 

The  peculiar  pallor  of  the  face,  which  in  some  cases  may  be 
of  a  slightly  brownish  or  greenish  tint. 

What  is  the  diagnosis  ? 

There  are  no  points  which  enable  one  to  distinguish  one  form 
of  enlargement  from  others.  The  tubercular  and  syphilitic 
spleen  are  more  often  associated  with  enlargement  of  the  liver 
than  are  rachitic  and  simple  enlargement  of  the  organ. 

The  blood,  upon  microscopical  examination,  will  show  a 
diminution  in  the  red  corpuscles. 


DISEASES    OF    THE    SPLEEN    AND    BLOOD.  125 

What  is  the  prognosis  ? 

Usually  unfavorable.  All  splenic  enlargements  respond  very 
slowly  to  drugs. 

What  is  the  treatment  ? 

A  syphilitic  spleen  will  require  mercury,  and  a  splenic  en- 
largement associated  with  malaria,  quinia.  As  all  forms  are 
associated  with  pallor,  either  arsenic,  iron  or  cod-liver  oil 
should  be  given. 

The  enlarged  spleen  of  rickets  usually  does  well  upon  a  diet 
of  good  food,  plenty  of  fresh  air,  and  half-drachm  doses  of  the 
syrup  of  the  lacto-phosphate  of  iron.  Oil  or  soap  liniment 
may  be  rubbed  over  the  surface  of  the  organ,  but  not  much 
success  must  be  looked  far. 

Purpura. 

What  is  the  definition? 

An  acute  disease,  characterized  by  a  purplish  mottling  of  the 
skin,  caused  by  hemorrhages  into  the  upper  layers  of  the  cutis 
and  beneath  the  epidermis. 

What  are  the  causes  ? 

Common  in  children  of  the  lower  classes,  probably  the  result 
of  bad  feeding,  overcrowding,  etc.  It  is  a  condition  which 
may  be  associated  with  many  diseases,  such  as  rickets,  rheu- 
matism, heart  disease,  and  by  the  administration  of  drugs, 
such  as  iodide  of  potassium. 

What  are  the  symptoms? 

The  child  may  seem  languid  and  fretful  for  a  few  days, 
probably  with  a  tenderness  of  the  mouth.  Now  the  body  may 
be  covered  with  purple  spots,  the  gums  bleed  and  are  much 
swollen.  All  parts  of  the  body  may  be  covered  with  small 
petechiae.  The  temperature  is  a  trifle  above  normal.  In 
severe  cases  there  may  be  bleeding  from  the  nose,  ears,  bow- 
els, and  kidneys. 


'  126  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  pathology  ? 

Nothing  is  known.  The  blood  has  been  examined  with 
negative  results. 

What  is  the  prognosis  ?     . 

Seldom  fatal,  except  when  associated  with  high  fever. 

What  is  the  treatment  ? 

If  the  attack  is  severe  the  child  should  be  kept  in  bed  per- 
fectly quiet.  The  bleeding  may  be  controlled  with  gallic  acid, 
oil  of  turpentine,  tincture  of  the  chloride  of  iron,  dilute  sul- 
phuric acid,  etc.  The  patient  should  be  given  a  good,  nutri- 
tious diet,  including  lime  or  lemon  juice  with  at  least  two 
meals. 

Haemophilia. 

What  is  the  synonym  ? 

Hemorrhagic  diathesis. 

What  is  the  definition  ? 

A  hereditary  condition,  characterized  by  the  habitual  occur- 
rence of  hemorrhages,  said  to  be  more  common  in  males. 

What  is  the  cause  ? 

Hereditary. 

What  are  the  symptoms? 

They  usually  show  themselves  within  the  first  year  or  two  of 
life,  by  either  bleeding  from  the  nose  or  mouth,  or  spontaneous 
ecchymoses  in  the  skin.  In  very  severe  cases  the  bleeding 
arises  spontaneously,  or  from  some  trivial  cause,  and  occurs  not 
only  in  the  skin  and  from  mucous  surfaces,  but  large  extravasa- 
tions take  place  into  the  subcutaneous  tissue  and  intermuscular 
septa,  and  into  the  cavities  of  the  larger  joints. 

What  is  the  pathology  ? 
Not  known. 


DISEASES    OF    THE    SPLEEN    AND    ELOOD.  127 

What  is  the  diagnosis? 

It  may  be  confounded  with  purpura  due  to  other  causes. 
The  family  and  personal  history,  and  sex  of  the  patient  must 
be  carefully  noted. 

What  is  the  prognosis? 

The  disease  is  usually  persistent  throughout  life,  and  there 
may  be  risk  of  life  at  any  time  from  profuse  hemorrhage. 

What  is  the  treatment? 

Preventive  treatment,  such  as  the  avoidance  of  an  injury; 
residence  in  a  warm,  even  climate;  warm  clothes;  good,  sub- 
stantial food,  etc.,  is  generally  of  much  value.  The  perchloride 
of  iron  is  said  to  be  the  best  remedy,  though  none  can  materi- 
ally influence  the  disease.  Should  the  hemorrhage  be  so 
severe  as  to  endanger  life  transfusion  must  be  resorted  to. 

Anaemia. 

What  is  the  definition  ? 

A  deficiency  of  red  corpuscles  in  the  blood,  characterized  by 
general  weakness  and  pallor,  common  at  all  ages,  from  a  few 
months  old  and  upward. 

What  are  the  causes  ? 

Insufficient  or  improper  food,  bad  air,  syphilis,  rickets, 
malaria,  and  unhealthy  hygienic  surroundings.  Frequently 
noticed  in  girls  of  twelve  or  fourteen  years  of  age  employed  in 
mills  ;  growing  too  fast,  violent  exercise,  and  hard  work. 

What  is  the  pathological  anatomy  ? 

The  microscope  shows  a  great  diminution  in  the  number  of 
the  red  blood  corpuscles,  and  a  slight  excess  of  the  white. 

What  are  the  symptoms  ? 

Pallor  of  the  face  ;  the  conjunctivse,  tongue,  and  gums  are 
pahi ;    the  appetite   is   poor,  and   the   bowels  constipated  ;   the 


128  ESSENTIALS    OF    DISEASES    OF    CfllLDREN. 

child  is  languid  and  ill-tempered  ;  the  heart  is  irritable,  and 
frequently  soft  systolic  murmurs  are  heard. 

What  is  the  diagnosis? 

As  an  anaemic  condition  may  be  associated  witii  so  many 
disorders  of  childhood,  all  other  diseases  must  be  excluded ; 
the  child  must  be  thoroughly  examined,  and  only  in  the  ab- 
sence of  actual  structural  changes  in  the  viscera,  in  the  absence 
of  syphilis,  ague,  or  malaria,  is  the  diagnosis  made. 

What  is  the  prognosis  ? 

Some  cases  of  simple  anaemia  will  be  found  very  obstinate, 
and  treatment  seems  of  little  avail,  whilst  others  respond 
more  quickly.  In  all  cases,  whether  slight  or  severe,  the 
prognosis  should  be  guarded. 

What  is  the  treatment? 

Before  employing  drugs  the  child's  mode  of  living  should  be 
carefully  looked  into  ;  the  sleeping-room,  the  food  and  clothing, 
and  its  general  habits  must  be  investigated.  If  these  are  found 
to  be  thoroughly  hygienic,  then  drugs  may  be  employed.  Iron 
in  some  form  is  the  most  valuable  remedy  ;  the  lactate  of  iron 
may  be  given  in  one  to  three  grain  doses,  as  follows : — 

^.     Ferri  Lactat.  gr.  xij. 

Pepsinse  Sacch.  gr.  xxxvj. 

Palv.  Aromat.  gr.  vj. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  three  times  a  day  for  a  child  of  two  years. 

Another  valuable  formula  is  arsenic  combined  with  iron. 

I^.     Liq.  Potass.  Arsenitis  TT^xyj. 
Villi  Ferri  Araar.  f  ^ij. — M. 
Sig.  From  one-half  to  one  teaspoonful  in  water  after  eating  three 
times  for  a  child  of  two  years. 

Iron  may  be  combined  with  cod-liver  oil,  malt  extract,  and 
quinine. 


DISEASES    OF    TFTE    SPLEEN    AND    BLOOD.  129 

The  following  prescription  is  used  at  the  Children's  Hospital 
of  Philadelphia  : — 

^.     Quiniae  Sulphat.  gr.  viij. 
Syr.  Ferri  lodid.  f  5iss. 
Gljcerinse, 
Syr.  Simp,  aa  f  ^j. 
01.  Anisi  gtt.  ij. — M. 
Sig.  Teaspoonful  three  times  a  day  for  a  child  of  two  years. 

In    addition    to    the    above    treatment  the  child  should   be 
allowed  plenty  of  fresh  air,  good,  nutritious  food,  etc. 


130  ESSENTIALS    OF    DISEASES    OF    CHILDKEN. 

PART    X. 

Diseases  of  the  Neivous  System. 

Simple  Meningitis. 

What  are  the  synonyms? 

Suppurative  meningitis ;  lepto-nieningitis. 

What  is  the  definition? 

An  acute  inflammation  of  the  membranes  of  the  brain ; 
cliaracterized  by  headache,  fever,  and  delirium. 

What  are  the  causes? 

Disease  of  the  ear  and  nose,  acute  fevers,  injuries,  exposure 
to  intense  heat  of  the  sun,  dentition,  and  sudden  change  of 
temperature. 

What  is  the  pathological  anatomy  ? 

The  inflammatory  changes  are  said  to  be  developed  at  the 
convexity  in  preference  to  the  base  in  infants,  although  basal 
meningitis  is  not  uncommon. 

The  dura  mater  is  much  injected,  and  the  cerebral  veins 
contain  coagulated  blood.  When  the  dura  mater  is  opened 
nearly  all  of  the  convex  surfaces  of  both  hemispheres  are 
covered  with  a  yellowish  or  greenish  substance,  consisting  of 
fluid  or  concrete  pus  or  false  membranes.  These  deposits  are 
also  found  at  the  base  of  the  brain,  the  upper  surface  of  the 
cerebellum,  and  the  internal  surfaces  of  the  hemispheres. 
The  pia  mater  is  the  seat  of  the  inflammatory  products,  also  the 
cavity  of  the  arachnoid  membrane,  but  in  much  smaller  quan- 
tity than  in  the  tissue  beneath. 

The  ventricles  seldom  contain  transparent  serum,  except  at 
a  very  early  age.  They  may  often  contain  from  one  drachm  to 
half  an  ounce  of  pus. 


DISEASES    OF    THE    NERVOUS    SYSTEM. 


131 


What  are  the  symptoms  ? 

Tlie  cliild  is  pale,  appetite  poor,  intense  thirst,  retraction 
of  head,  and  screaming  if  moved,  the  bowels  are  constipated, 
and  the  abdomen  retracted.  Tliere  is  fever  and  vomiting,  the 
expression  of  the  face  is  wild,  muttering  delirium,  grinding  of 
the  teeth,  subsultus  tendinum,  convulsive  movements,  stiffening 
of  the  extremities,  strabismus,  contraction  first,  and  then  dila- 
tation of  the  pupils,  and  in  some  cases  convulsions,  followed 
by  deep  coma. 

What  is  the  prognosis  ? 

Usually  grave,  although  under  careful  treatment  and  nursing 

patients  recover. 

What  is  the  diagnosis? 

In  young  children  the  symptoms  are  obscure,  and  when^  the 
diao-nosis  of  meningitis  is  settled  upon  the  question  is  whether 
it  is  tubercular  or  not.  M.  Rilliet  draws  the  following  distinc- 
tions : — 

Tubercular  Meningitis. 

1.  Occurs  in  weak  precocious  chil- 
dren. 

2.  Always  sporadic. 

3.  Never  at  onset. 

4.  The  disease  makes  headway 
insidiously. 

5.  Obstinate  constipation,  late 
vomiting,  tranquil  delirium, 
little  fever. 

6.  The  reverse  of  this. 


Simple  Meningitis. 

1.  Occurs  in  healthy  children. 

2.  May  be  epidemic. 

3.  May  commence  with  convul- 
sions. 

4.  The  attack  is  sudden. 

5.  Headache  more  intense,  vomit- 
ing, violent  delirium,  fever, 
coma. 

'6.  Progress  rapid  ;  duration  short. 

Retraction  of  the  neck,  pain  on  movement,  pain  in  the  head, 
rigidity  of  the  muscles,  causeless  vomiting,  flattened  abdomen, 
fever,  intolerance  of  light,  irregularity  of  the  pulse,  delirium, 
constipation  and  weakness.  From  acute  urtemia  ;  in  tliis  the 
temperature  is  low,  casts  and  albumen  in  the  urine.     Previous 


132  ESSENTIALS    OP'    DISEASES    OF    CHILDREN. 

history  as  to  ear  discharges  is  always  of  service  in  aiding  the 
diagnosis. 

What  is  the  treatment  ? 

Iodide  of"  potassium  may  be  given  in  the  hope  that  it  will 
absorb  the  inflammatory  material.  It  may  be  combined  with 
small  doses  of  calomel.  Shaving  the  head  and  counter-irrita- 
tion may  be  employed,  although  an  ice-cap  kept  constantly  to 
the  head  is  generally  all  that  is  necessary. 

Should  the  temperature  run  high  quinine  may  be  given. 
The  constipation  may  be  relieved  by  an  aperient.  Any  vio- 
lent delirium  must  be  controlled  by  the  bromide  of  potassium 
or  sodium,  chloral  or  Dover's  powder.  The  symptoms  have 
often  subsided  after  incising  the  membrana  tympani,  discharg- 
ing a  small  amount  of  pus.  The  child  should  be  kept  in  a 
moderately  cool  room,  and  the  head  kept  high.  The  food 
should  consist  of  milk,  milk  punch,  animal  brotlis,  etc. 

Tubercular  Meningitis. 

What  is  the  synonym  ? 

Basilar  meningitis. 

What  is  the  definition? 

An  inflammation  particularly  of  the  pia  mater  of  the  brain, 
due  to  the  deposit  of  gray  miliary  tubercle. 

What  are  the  causes  ? 

Scrofulous  diathesis ;  hereditary  diathesis  ;  occurs  in  children 
from  the  second  to  the  seventh  year. 

What  is  the  pathological  anatomy  ? 

Tubercle  is  usually  deposited  at  the  base  of  the  brain. 

Grayish-white  granules  are  distributed  along  the  vessels  of 
the  pia  mater,  causing  inflammation  and  the  exudation  of 
lymph. 


DISEASES    OF    THE    NERVOUS    SYSTEM.  133 

The  cerebral  tissue  is  seldom  involved.  The  ventricles  are 
distended  by  a  clear  or  bloody  serum. 

The  tubercular  deposits  may  occur  in  the  lungs,  intestines, 
liver,  kidneys,  etc. 

What  are  the  symptoms  ? 

General  wasting,  disturbed  sleep,  bad  dreams,  grinding  the 
teeth,  pain  in  the  head,  a  short  sharp  cry  and  irregularity  of  the 
pulse.     As  the  disease  matures  the  cerebral  symptoms  are  more 
marked.     The  child  sleeps  with  half  closed  eyes,   and  often 
awakes  in  alarm.     The  patient  has  a  pinched,  drawn,  haggard 
expression  which   is   very  characteristic.     The   respiration   is 
quicken^  and  irregular,  accompanied  with  sighing  and  yawn- 
ing;   the   temperature    is   slightly  elevated.     The  child   may 
remain  in  this  condition  from  three  to  four  days.     Now  the 
child  wishes  to  be  left  alone  ;  at  night  there  is  considerable 
delirium  ;  the  pulse  is  slower  and  more  irregular,  there  is  more 
stupor  and  insensibility  ;  the  child  is  constantly  frowning,  and 
the  face  is  flushed ;  the  head  is  hot,  and  the  piercing  "  cri  hy- 
drocephalique'"  is   increased.      The  pupils  may  be   unequally 
dilated,   or   strabismus   is   present.      The   abdomen   is    much 
retracted.      Increased  stupor  now  appears,  interrupted,  how- 
ever, by  convulsions.     The  pulse  becomes  smaller  and  there 
are  clammy  sweats.     The  pupils  are  widely  dilated,  the  eyes 
staring  and  deep  in  their  sockets.     Convulsions  now  are  con- 
stantly occurring,  soon  causing  death. 

What  is  the  diagnosis  ? 

The  chief  difficulty  is  to  diagnose  the  disease  from  typhoid 
fever.  The  latter  is  only  common  in  children  above  five  years 
of  age ;  there  is  seldom  vomiting,  and  tlie  bowels  are  usually 
relaxed.  There  is  tenderness  and  gurgling  in  the  right  iliac 
fossa ;  the  abdomen  is  tumid  and  flatulence  is  present.  Con- 
vulsions and  paralysis  are  rare.     Rose  spots  are  usually  present. 


184  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

The  "•  tache-meningiti que^^  (a  red  line  remaining  on  the  skin 
after  tlie  finger  has  been  drawn  along  it),  is  absent  in  typhoid 
fever,  and  always  present  in  tubercular  meningitis.  From 
simple  meningitis,  see  table  on  page  131. 

What  is  the  prognosis  ? 

Very  grave,  altliough  instances  of  recovery  have  been  re- 
ported. 

What  is  the  treatment  ? 

When  a  child  of  a  family  dies  of  hydrocephalus,  the  health 
of  the  parents  sliould  be  looked  into  and  improved  as  far  as 
maybe  practicable.  Should  the  mother  bear  another  child  she 
must  not  suckle  it,  but  have  it  reared  by  a  healthy  wet  nurse 
or  artificially  fed.  As  it  grows  older  its  hygienic  surroundings 
should  be  carefully  watched.  His  diet  must  be  plain  and 
nourishing ;  he  must  wear  flannel  next  to  the  skin,  and  con- 
stantly kept  in  the  open  air.  During  the  winter  months  it 
would  be  well  to  give  him  a  mixture  of  cod-liver  oil  with  the 
lacto-phosphate  of  lime,  or  malt-extract  with  the  syrup  of  the 
iodide  of  iron;  the  bowels  should  be  carefully  regulated,  and 
every  tendency  to  illness  watched. 

The  disease  runs  its  course,  and  nothing  will  retard  it. 
Symptoms  should  be  treated  as  they  arise.  It  is  well  to  give 
tlie  iodide  of  potassium  and  mercury  at  the  onset ;  iodoform  is 
recommended  in  very  young  children  in  doses  of  one-half 
increased  gradually  to  one  grain. 

The  child  should  be  kept  in  bed  and  not  allowed  to  see 
visitors.  An  ice-cap  should  be  kept  constantly  to  his  head, 
and  sleeplessness  combated  with  chloral  or  the  bromide  of 
potassium ;  the  diet  should  be  light,  consisting  of  milk,  egg, 
clear  soup,  etc. 


DISEASES    OF    THE    NERVOUS    SYSTEM.  135 

Acute  Hydrocephalus. 

What  is  the  synonym  ? 

Acquired  hydrocephalus. 

What  is  the  definition  ? 

An  equable  enlargement  of  the  cavity  of  the  skull,  caused 
by  fluid  in  the  arachnoid  spaces,  the  pia  mater,  the  ventricles, 
and  brain  substance. 

What  are  the  causes  ? 

Usually  occurs  in  children  between  the  ages  of  one  and  six 
years.  Bad  hygienic  surroundings,  tubercular  deposits  in  the 
pia  mater,  blows  on  the  head,  eruptive  fevers,  dentition,  dis- 
eases of  the  right  heart,  and  Bright's  disease. 

• 

What  is  the  pathological  anatomy  ? 

The  effusion  is   not  only  limited  to  the   ventricles,  but  is 

found   in   the   arachnoid  spaces,  pia   mater,   and   surrounding 

portions  of  the  brain. 

What  are  the  symptoms  ? 

The  child  is  restless  and  loses  its  appetite  ;  there  is  fever, 
vertigo,  headache,  delirium,  twitching  of  the  muscles,  hyper- 
aesthesia  of  the  skin.  These  symptoms  may  continue  for  three 
or  four  days,  when  convulsions  appear,  usually  causing  death. 

What  is  the  prognosis  ? 

Unfavorable. 

What  is  the  treatment  ? 

No  treatment  is  of  much  value.  Iodide  of  potassium  may 
be  given  to  promote  absorption  of  the  fluid.  The  convulsions 
should  be  controlled  with  chloral  and  the  bromide  of  potassium 
or  sodium. 


136  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Congenital  Hydrocephalus.         * 

What  is  the  synonym  ? 

Chronic  hydrocephalus. 

What  is  the  definition  ? 

An  accumulation  of  the  cerebro-spinal  fluid  in  the  ventricles 
of  the  brain,  which  is  known  as  internal  hydrocephaly s,  and 
in  tlie  pia  mater,  which  is  known  as  external  hydrocephalus. 
Wlien  the  fluid  occurs  in  both  it  is  known  as  mixed  hydro- 
cephalus. 

What  are  the  causes  ? 

Arrested  development  of  the  brain.  Occurs  in  children  of 
scrofulous,  tubercular,  and  syphilitic  parents. 

What  is  the  mfirbid  anatomy  ? 

The  fluid  is  found  between  the  dura  mater  and  the  cranium  ; 
between  the  dura  mater  and  the  arachnoid  ;  in  the  meshes  of 
the  pia  mater,  and  most  commonly  in  the  ventricles.  The  posi- 
tion of  the  fluid  materially  affects  the  other  morbid  conditions. 
Compression  from  without  reduces  the  brain  to  a  small  size, 
and  distention  from  within  will  render  it  a  thin,  membranous 
bag. 

The  membranes  may  be  either  free  from  change  or  show 
signs  of  inflammation.  It  is  quite  difficult  to  recognize  the 
difference  between  the  white  and  gray  matter. 

What  are  the  symptoms  ? 

The  gradual  enlargement  of  the  head  is  first  noticed.  The 
child  is  emaciated,  although  the  appetite  is  good.  There  is 
drowsiness,  and  some  dulling  of  the  intellectual  powers.  The 
head  appears  too  large  for  the  small,  wrinkled,  and  pinched 
face,  and  too  heavy  for  the  child  to  support.  As  the  size  of 
the  head  increases  it  becomes  so  heavy  that  the  child  is  unable 
to  hold  it  erect,  and  it  hangs  first  on  one  or  the  other  side. 


DISEASES    OF    THE    NERVOUS    SYSTE.M.  137 

The  face  is  devoid  of  expression,  and  the  eyes  usually  have  a 
downward  expression.  The  voice  is  feeble  and  the  cry  short 
and  shrill.  These  symptoms  increase  daily  until  convulsions 
occur,  which  usually  end  fatally. 

The  majority  of  cases  of  congenital  hydrocephalus  terminate 
fatally  during  the  first  year  of  life.  Cases  have^been  reported 
of  patients  living  from  ten  to  fifteen  years  or  more. 

What  is  the  diagnosis  ? 

The  enlargement  of  the  skull  is  frequently  mistaken  for  the 
skull  of  rachitis,  although  the  latter  is  quite  different.  The 
rachitic  skull  is  long  and  laterally  compressed,  the  forehead  is 
high  and  square  ;  the  hydrocephalic  skull  is  enlarged  in  all 
directions,  with  an  overhanging  of  the  forehead,  prominent 
and  divergent  eyeballs. 

What  is  the  prognosis  ? 

Unfavorable,  although  cures  are  reported. 

What  is  the  treatment  ? 

Goiis  recommends  the  following  plan  :  Calomel  in  quarter 
to  half-grain  doses  twice  daily,  together  with  the  inunction  of 
one  or  two  drachms  of  mercurial  ointment  into  the  scalp  once 
a  day,  protecting  the  head  from  cold  with  a  flannel  cap,  which 
is  worn  constantly. 

Another  plan  is  to  strap  the  head  with  adhesive  plaster,  re- 
leasing it  if  symptoms  of  compression  arise. 

Paracentesis  may  be  performed  by  puncturing  the  skull  with 
a  small  trocar  and  canula  at  the  coronal  suture,  about  one  inch 
and  a  half  from  the  anterior  fontanelle,  care  being  taken  to 
avoid  the  longitudinal  sinus.  A  small  portion  of  the  fluid 
should  only  be  removed  at  a  time,  care  being  taken  to  main- 
tain even  pressure  between  the  tappings. 

The  child  should  be  given  the  iodide  of  potassium  and  syrup 
of  the  iodide  of  iron  and  cod-liver  oil.  The  food  must  consist 
of  animal  broths,  milk,  etc. 


138  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Encephalic  Tumors. 

What  is  the  definition  ? 

Tumors  of  the  brain,  seated  chiefly  in  the  cerebellum,  found 
principally  in  tubercular  children. 

What  are  the  symptoms  ? 

Intense  occipital  headache  and  vomiting,  congestion,  swell- 
ing, and  neuritis  of  the  optic  nerves,  followed  by  white  atrophy 
and  blindness.  The  gait  is  reeling,  and  tonic  convulsions  or 
rigidity,  movements  of  the  eyeballs,  enlargement  of  the  occi- 
pital segments  of  the  head,  hydrocephalus,  and  craniotabes 
may  be  present. 

What  is  the  morbid  anatomy  ? 

The  commonest  form  of  tumor  of  the  brain  is  solitary  tubercle. 
It  is  most  frequently  found  in  the  posterior  part  of  one  or  otiier 
lateral  lobe,  and  occasionally  a  small  mass  is  found  in  the  oppo- 
site lobe.  Gliomatous  growths,  cystic  tumors,  or  simple  cysts 
may  also  exist. 

What  is  the  diagnosis  ? 

Tlie  unsteady  movements  in  walking,  optic  neuritis,  rigidity, 
perverted  movements  of  the  eyeballs,  screaming  spells,  etc. 

What  is  the  prognosis? 

Always  grave. 

What  is  the  treatment? 

The  child  should  have  careful  nursinoj  and  a  light  but  nutri- 
tious  diet.  For  the  relief  of  the  intense  pain  opium  should  be 
employed,  or  the  bromide  of  potassium  or  sodium  combined 
with  chloral.     Dr.  Goodhart  thinks  it  justifiable  to  trephine. 


DISEASES  OF  THE  NERVOUS  SYSTEM.         139 

Cerebral  Hemorrhage. 

What  is  the  synonym  ? 

Apoplexy. 

What  is  the  definition  ? 

An  effusion  of  the  blood  into  the  substance  of  the  brain, 
caused  by  the  sudden  rupture  of  a  bloodvessel. 

What  are  the  causes  ? 

Usually  rare  in  children  ;  chief  cause,  disease  of  the  blood- 
vessels ;  embolism  ;  cardiac  hypertrophy  ;  hereditary  tendency, 
etc. 

What  are  the  symptoms? 

Heaviness,  drowsiness,  and  headache,  passing  slowly  into 
stupor  ;  or  the  attack  may  be  quite  sudden,  appearing  as  coma, 
convulsions,  or  paralysis. 

What  is  the  pathological  anatomy  ? 

A  clot  may  be  found  in  the  brain,  usually  in  the  neighbor- 
hood of  the  corpora  striata  and  optic  thalami. 

What  is  the  diagnosis  ? 

This  depends  mostly  upon  the  evidence  of  heart  disease,  or 
of  some  reason  for  the  formation  of  clots  on  the  valves  or  in 
the  cavities,  such  as  rheumatism,  chorea,  scarlatina,  and  ty- 
phoid fever. 

What  is  the  prognosis? 
Grave. 

What  is  the  treatment  ? 

Absolute  rest  in  bed,  ice  to  the  head ;  the  bowels  should  be 
kept  freely  opened  and  nourishment  must  be  given  in  small 
quantities  at  frequent  intervals.  As  in  adults,  the  child  should 
be  frequently  changed  from  side  to  side  to  prevent  the  accumu- 
lation of  mucus  at  the  base  of  the  lungs. 

In  cases  of  apoplexy  due  to  valvular  disease,  one  or  two 


140  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

grains  of  quinine  may  be  given  if  pyrexia  is  present,  and  the 
heart's  action  should  be  quieted  and  sustained  by  the  adminis- 
tration of  bromide  of  potassium,  belladonna,  or  digitalis. 

Infantile  Paralysis. 

What  is  the  synonym  ? 

P^ssential  paralysis  of  children. 

What  is  the  definition  ? 

An  inflammation  of  the  anterior  horns  of  the  gray  matter  of 
the  cord  occurring  suddenly  in  children ;  characterized  by 
slight  fever,  muscular  tremors,  and  paralysis  of  groups  of 
muscles. 

What  are  the  causes  ? 

Children  of  rheumatic  parents  seem  to  be  more  prone  to  the 
disease.  The  exciting  causes  are  exposure  to  cold,  dentition, 
injuries  to  the  spine.     It  often  follows  the  acute  exanthemata. 

What  is  the  pathological  anatomy  ? 

Medullary  hyperasmia,  vascular  exudation,  and  inflammatory 
softening.  Microscopically  the  anterior  horns  of  the  gray 
matter  are  inflamed  and  much  softened. 

What  are  the  symptoms  ? 

The  onset  is  usually  sudden,  commencing  with  a  mild  fever, 
which  is  often  remittent  and  lasting  a  few  days,  then  subsides, 
and  the  child  is  found  to  be  paralyzed.  In  rare  cases  the 
paralysis  may  be  ushered  in  with  convulsions.  Many  children 
go  to  bed  apparently  well  and  are  found  paralyzed  in  the  morn- 
ing. Both  arms  and  both  legs  may  be  affected,  or  only  one  arm 
and  one  leg. 

The  temperature  of  the  paralyzed  limbs  is  always  sub-normal, 
and  the  muscles  slowly  waste  until  all  muscular  tissue  is  gone. 

What  is  the  diagnosis  ? 

Usually  quite  easy  where  the  paralysis  appears  suddenly  in 


DISEASES    OF    THE    NERVOUS    SYSTEM.  141 

the  midst  of  apparently  good  health.  From  pseudo-hypertrophic 
paralysis  :  this  disease  has  no  stage  of  fever,  and  the  paralyzed 
muscles  are  increased  in  size. 

What  is  the  prognosis  ? 

Rarely  threatens  life,  although  complete  recovery  is  rare. 

What  is  the  treatment? 

The  primary  fever  should  be  treated  with  aconite  or  the  solu- 
tion of  the  citrate  of  potassium.  When  the  paralysis  appears 
the  child  should  have  complete  rest.  Half  a  grain  of  the  iodide 
of  potassium  may  be  given  with  a  drop  or  two  of  the  tincture 
of  digitalis  every  three  hours.  The  iodide  of  potassium  may 
be  replaced  by  a  grain  of  mercury  with  chalk  or  by  rubbing 
mercurial  ointment  over  the  region  of  the  cord,  which  corre- 
sponds to  the  paralysis.  Ice  compresses  to  the  spine,  and  cool 
or  cold  bath  followed  by  brisk  rubbing  will  be  found  useful. 
Mild  galvanism  should  be  employed,  and  quinia,  belladonna, 
and  ergot  given  internally. 

In  applying  electricity  much  care  and  tact  are  required, 
especially  if  the  child  be  under  six  years.  The  weakest 
currents  should  be  employed  at  first,  gradually  increasing  the 
strength  as  the  child  becomes  used  to  the  sensation.  Massage 
to  the  paralyzed  limb  will  be  found  of  service.  Tiie  tincture 
of  nux  vomica  may  be  given  in  the  following  mixture  : — 

I^.     Tr.  Nucis  Vomicae  n\^xxiv. 
Syr.  Simp.   ^ss. 

Elix.  Calissayae  q.  s.  ad  ffiij. — M. 
Sig.  Teaspoonful  three  times  a  day  for  a  child  of  three  years. 

Hypodermic  injections  of  the  sulphate  of  strychnia  in  doses 
of  ^1^  to  ^\^  of  a  grain  two  or  three  times  a  week,  in  connec- 
tion witli  faradisatioti  to  the  paralyzed  muscles,  will  be  found 
useful.     The  affected  parts  should  be  kept  perfectly  warm. 


142  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Pseudo -hypertrophic  Paralysis. 

What  are  the  synonyms? 

Pseudo-hypertrophic  spinal  paralysis ;  fatty  muscular  hyper- 
trophy. 

What  is  the  definition  ? 

A  disease  characterized  by  progressive  loss  of  power  appear- 
ing in  certain  groups  of  muscles,  until  nearly  all  the  muscles 
of  the  body  are  involved. 

What  are  the  causes'? 

Attacks  children  almost  exclusively,  and  appears  to  be  he- 
reditary ;  is  most  frequent  in  boys. 

What  is  the  morbid  anatomy? 

The  muscles  will  be  found  in  the  early  stages  to  be  sepa- 
rated by  growths  of  fat  in  the  interstitial  tissues ;  in  the  later 
stages  they  are  almost  crowded  out  by  fat. 

The  spinal  cord  is  seldom  foond  diseased,  and  the  general 
opinion  is  that  the  affection  is  a  local  one  of  muscular  origin. 

What  are  the  symptoms? 

The  child  will  usually  begin  to  walk  late,  and  then  walk 
imperfectly ;  or  children  that  have  been  w^alking  for  several 
years  will  complain  of  feeling  tired,  and  a  peculiarity  will  soon 
be  noticed  in  their  gait.  In  a  few  cases  reported,  pains  in  the 
limbs  have  been  complained  of  in  the  early  stage.  When  the 
disease  is  established  the  mode  of  walking  and  standing  is 
very  characteristic.  The  child  soon  discovers  that  without 
support  these  operations  become  more  painful  and  difficult 
each  day.  In  order  to  keep  their  equilibrium  the  lower  dorsal 
and  lumbar  spine  is  arched  forward,  while  the  upper  part  of 
the  spine,  the  shoulders,  and  head,  are  bent  backwards. 
The  legs  are  widely  separated,  and  in  walking  the  body  is 
inclined  laterally  towards  the  leg  which  rests  on  the  ground; 


DISEASES    or    THE    NERVOUS    SYSTEM.  US 

this  produces  a  characteristic  balancing  of  tlie  body  durin<? 
locomotion,  while  the  legs  are  advanced  in  jerks.  The  calf 
muscles  are  usually  the  first  to  enlarge,  then  the  glutei  follow, 
and  finally  other  muscles  of  the  thigh,  pelvis,  trunk,  and  upper 
extremities  become  involved.  Niemeyer  speaks  of  his  patient 
as  looking  "as  if  he  had  the  body  and  head  of  a  weak  child 
on  the  hips  and  thighs  of  a  strong  man.'* 

What  is  the  duration  ? 

May  vary  from  five  to  fifteen  years  or  even  longer. 

What  is  the  prognosis? 

Patient  may  live  for  a  number  of  years.  Death  usually 
comes  at  last  from  exhaustion. 

What  is  the  diagnosis  ? 

The  two  diseases  it  needs  chiefly  to  be  distinguished  from  are 
infantile  paralysisand  progressive  muscular  atrophy.  Theformer 
affection  comes  on  very  suddenly,  and  the  latter  is  quite  rare. 

What  is  the  treatment  ? 

The  results  of  treatment  are  very  unsatisfactory.  The  pa- 
tient's general  health  should  be  supported  by  a  nutritious  diet. 
The  drugs  to  be  employed  are  cod-liver  oil,  iron,  the  com- 
pound syrup  of  the  hypophosphates,  and  arsenic.  The  affected 
muscles  should  be  manipulated  and  faradised.  Benedikt  has 
attained  good  results  in  three  cases  by  the  use  of  the  direct 
current,  the  copper  pole  being  placed  over  the  cervical  gang- 
lion, and  the  zinc  pole  along  the  side  of  the  lumbar  vertebrae 
by  means  of  a  broad  metal  plate. 

Torticollis. 

What  are  the  synonyms  ? 
Wry  neck  ;  stiff  neck. 

What  is  the  definition  ? 

A  rheumatic  pain  involving  the  muscles  of  the  neck,  usually 


144  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

limited  to  one  side  ;  characterized  by  great  pain  in  attempting 
to  turn  the  neck  in  the  opposite  direction. 

What  are  the  causes  ? 

Cold  and  exposure ;  a  frequent  affection  of  childhood.  It 
occurs  in  rheumatic  families,  in  anaemic  children,  or  those  run 
down  in  health  ;  it  may  also  occur  from  the  reflex  irritation  of 
enlarged  glands  and  decayed  teeth. 

What  is  the  diagnosis  ? 

Cannot   well   be   mistaken ;   pain   on   turning   head ;   rarely 

fever,  etc. 

What  is  the  treatment  ? 

Local  anodynes  to  relieve  pain  ;  liot  fomentations  to  neck ; 
saline  laxatives,  such  as  the  effervescing  citrate  of  magnesium, 
and  general  tonic  treatment ;  hypodermic  injections  of  atropia 
and  morphine  into  the  affected  muscle. 

Spastic  Rigidity. 

What  is  the  definition  ? 

An  idiopathic  muscular  contraction  of  different  flexor  muscles 
of  the  extremities,  especially  of  the  fingers  and  toes,  existing 
independently  of  any  recognizable  disease  of  the  cerebro-spinal 
system. 

What  are  the  causes  ? 

Most  common  between  one  and  three  years  of  age.  It  is 
usually  sympathetic  in  its  origin..  The  causes  are  gastro- 
intestinal irritation,  dentition,  etc.  It  may  also  be  symptomatic 
of  diseases  of  the  brain,  as  tubercle  and  meningeal  hemor- 
rhage. 

What  are  the  symptoms  ? 

When  the  disease  is  fully  manifested  the  thumbs  are  drawn 
into  the  palms  of  the  hands,  with  the  fingers  flexed  and  cover- 


DISEASES    OF    THE    NERVOUS    SYSTEM.  145 

ing  the  thumbs.  The  contraction  may  extend  to  the  wrists, 
forearm,  and  in  rare  cases  to  the  arms.  The  toes  are  also  in  a 
state  of  muscular  flexion  or  extension,  and  the  foot  extended 
upon  the  leg;  it  is  unusual  for  the  spasm  to  extend  to  the  knee. 

The  child  complains  of  pain  in  the  affected  parts,  and  is  rest- 
less and  irritable,  but  the  mind  is  perfectly  clear.  Convulsions, 
strabismus,  and  other  indications  of  nervous  disorder  may  occa- 
sionally occur. 

The  child  may  remain  in  this  condition  for  weeks  or  even 
months,  the  disease  either  slowly  increasing  in  severity  or  re- 
maining the  same.  When  improvement  appears  it  is  often 
intermittent,  the  intermissions  becoming  longer  and  longer  as 
restoration  to  health  progresses. 

What  is  the  prognosis  ? 

Not  very  hopeful.     When   death  occurs  it  is  usually  from 

convulsions. 

What  is  the  treatment  ? 

The  cause  must  be  first  discovered  and  treated.  If  from 
gastro-intestinal  irritation,  the  diet  should  be  carefully  regu- 
lated and  appropriate  drugs  administered.  If  from  difficult 
dentition,  the  lancing  of  the  gums  will  be  of  much  service. 
The  local  spasm  is  "best  relieved  by  warm  baths  ;  bromide  of 
potassium,  belladonna,  and  oxide  of  zinc  will  be  found  useful. 

Infantile  Convulsions. 

What  is  the  definition  ? 

A  paroxysm  of  variable  duration,  usually  attended  with  un- 
consciousness, and  followed  by  stupor. 

What  are  the  causes  ? 

Dentition,   worms,    indigestible   food,    excited    play,    brain 
disease,  rickets,  and  some  acute  exanthem.     Goodhart  classes 
10 


146  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

all  convulsions  under  two  years  of  age  as  "  infantile,"  and  all 
over  that  age  as  epilepsy. 

What  are  the  symptoms  ? 

The  child  becomes  pale,  the  eyes  are  turned  upward,  tlie 
face  gets  almost  black,  and  the  lips  become  livid.  Infants 
frequently  give  a  violent  scream  before  becoming  convulsed. 
Some  cases  lose  consciousness  only,  and  suddenly  awake  with 
a  start.  Sometimes  the  whole  body  becomes  stiff  with  im- 
peded breathing,  twitching  of  the  lips,  half-closed  eyes,  sudden 
starting,  and  carpo-pedal  contractions  ;  the  thumbs  are  bent 
across  the  palms  of  the  hands,  the  sole  of  the  foot  is  arched, 
and  the  toes  flexed.  A  child  may  have  several  convulsions 
in  one  day,  or  they  may  occur  at  intervals  of  weeks. 

What  is  the  diagnosis  ? 

If  we  can  by  careful  questioning  exclude  brain  disease  and 
one  of  the  exanthemata  the  diagnosis  will  most  likely  rest 
betw^een  difficult  dentition  and  indigestion,  or  perhaps  consti- 
pation. 

What  are  the  results  ? 

Hemiplegia,  which  may  only  be  of  temporary  duration. 
Children  frequently  stammer  and  are  dull  after  a  fit  ;  and 
cases  of  idiocy  have  been  reported  where  the  first  note  of  evil 
was  a  convulsion.  Strabismus  is  said  to  be  one  of  the  most 
common  results  of  a  convulsion. 

What  is  the  prognosis  ? 

Children  frequently  die  in  convulsions  at  an  early  period  of 
life.  Frequent  and  very  violent  convulsions  should  always  be 
looked  upon  with  much  anxiety.  The  prognosis  is  always 
grave  when  scarlatina  or  measles  are  ushered  in  with  a  con- 
vulsion. When  associated  with  dentition,  indigestion,  etc., 
the  outlook  is  not  so  grave,  and  by  removing  the  cause  and 
proper  treatment  few  deaths  ensue. 


DISEASES    OF    THE    NERVOUS    SYSTEM.  147 

What  is  the  treatment  ? 

The  child  should  at  once  be  placed  in  a  hot  mustard  bath, 
covering  the  body  well  up  to  the  neck,  and  an  ice-bag  applied  to 
the  head,  and  an  aperient  given  ;  two  grains  of  calomel  may  be 
given  to  a  child  a  year  old ;  if  the  gums  are  hot  and  swollen 
they  should  be  lanced.  When  the  child  becomes  conscious  the 
bromide  of  potassium  should  be  given  in  moderately  large 
doses  ;  for  instance,  ten  grains  of  the  bromide  may  be  given  to 
a  child  of  one  year.  Chloral  may  be  employed  with  advantage 
in  doses  of  from  three  to  five  grains  by  enema.  The  child, 
after  the  convulsion,  should  be  kept  perfectly  quiet  in  a  dark- 
ened room,  and  given  a  light  diet.  It  is  well  to  administer 
the  bromide  in  moderate  doses  for  the  next  week. 


Epilepsy. 

What  is  the  definition  ? 

A  chronic  disease  characterized  by  convulsive  attacks  and  a 
sudden  loss  of  consciousness. 

What  are  the  causes  ? 

Fright,  injuries  to  the  head,  hereditary,  gastro-intestinal  dis- 
turbance, sun-stroke,  worms  and  dentition. 

What  is  the  morbid  anatomy  ? 

No  characteristic  primary  anatomical  changes  known. 

What  are  the  symptoms  ? 

!So  far  as  the  symptoms  in  the  actual  fit  are  concerned,  they 
do  not  differ  from  those  seen  in  the  adult.  Children  will  some- 
times have  a  violent  convulsion,  and  insensibility  succeeded 
by  stupor;  but  tlie  greatest  number  simply  faint  and  lose  con- 
sciousness for  a  minute  or  so,  and  may  have  several  recurrences 
during  the  twenty-four  hours.  The  fits  of  children  usually 
occur  at  night. 


148  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  diagnosis  ? 

Usually  easy  if  a  careful  history  of  the  case  is  elicited. 

What  is  the  progncsis? 

About  the  same  as  in  adults.  Many  children  improve  when 
kept  under  proper  treatment  while  others. are  very  obstinate. 
If  the  fits  are  very  frequent  and  violent,  imbecility  may  follow. 

What  is  the  treatment? 

The  child's  general  health,  his  food,  and  hygienic  surrounding 
should  be  carefully  looked  into.  He  should  be  kept  upon  a 
good  nutritious  diet  with  but  little  meat.  The  bromide  of 
potassium  will  be  found  the  most  useful  of  all  drugs  for  the 
arrest  of  the  convulsions.  It  may  be  given  in  doses  of  from 
five  to  twenty  grains  three  times  a  day  to  children  from  one  to 
twelve  years  of  age.  Goodhart  prefers  the  bromide  of  sodium 
to  that  of  potassium  in  children.  Should  the  child  have  a 
neurotic  heart  digitalis  or  belladonna  may  be  combined  with  the 
bromide  of  potassium  or  sodium.  Occasionally  arsenic  or 
strychnia  will  be  found  of  much  service.  Borax  is  said  to  be 
of  value. 

Night  Terror. 

What  is  the  synonym  ? 
I^ight-mare. 

What  is  the  definition  ? 

A  nervous  affection  of  young  children  characterized  by  the 
child  suddenly  awaking  from  a  sound  sleep  and  uttering  loud 
and  terror  stricken  cries. 

What  are  the  causes? 

Indigestion,  constipation,  and  any  great  mental  excitement 
before  retiring.  It  usually  occurs  in  children  who  are  quick, 
excitable,  and  nervous ;  it  is  also  said  to  run  in  rheumatic  and 
choreic  families. 


DISEASES    OF    THE    NERVOUS    SYSTEM.  149 

What  are  the  symptoms  ? 

The  child  goes  to  bed  apparently  well  to  all  appearances, 
but  in  a  few  hours  after  he  has  been  asleep  he  suddenly  awakes 
in  great  alarm,  and  utters  piercing  cries.  For  some  minutes 
he  will  not  recognize  his  parents  or  nurse,  and  will  point  to 
different  parts  of  the  room  with  an  expression  of  great  alarm, 
and  will  often  imagine  that  some  huge  animal  is  about  to  attack 
him.  Finally  he  becomes  more  composed  and  falls  sobbing  to 
sleep  in  the  arms  of  his  mother  or  nurse. 

What  is  the  treatment  ? 

The  child  should  never  be  allowed  to  sleep  alone ;  the  diet 
must  be  of  the  plainest  after  the  mid-day  meal.  Bromide  of 
potassium  and  chloral  are  the  drugs  to  be  employed,  and  the 
former  should  be  given  daily  until  the  terrors  cease. 

Idiocy. 

What  is  the  definition  ? 

*'  A  mental  deficiency,  or  extreme  stupidity,  depending  upon 
mal-nutrition  or  disease  of  the  nervous  centres,  occurrintj  eitiier 
before  birth,  or  before  the  evolution  of  the  mental  faculties  in 
childhood."  (Dr.  Irelami.) 

What  are  the  causes  ? 

Idiocy  may  be  congenital  or  acquired  ;  the  former  cases  are 
usually  microcephalic,  and  the  latter  are  common  after  convul- 
sions. A  long-continued  attack  of  chorea  is  apt  to  degenerate 
into  idiocy ;  scrofula,  epilepsy,  injury  to  the  brain,  a  blow  or 
fall  on  the  head,  masturbation,  and  alcoholic  excesses  of  either 
parent,  is  one  of  the  causative  factors. 

What  is  the  morbid  anatomy  ? 

In  some  cases  the  brain  will  be  found  very  small,  or  the 
convolution  may  be  rudimentary  or  simple.  One  part  or  other 
may  be   ill-developed  or  even  absent.     In  the  acquired  form 


150  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

thick  membranes,   pachymeningitis,  cysts,  thickening    or   de- 
formity of  the  skull,  may  be  found. 

What  are  the  symptoms? 

The  grave  cases  have  no  natural  sense  of  any  kind  ;  the 
mind  remains  in  an  undeveloped  state  ;  the  child  cannot  walk 
or  talk  properly ;  he  may  often  be  deaf,  and  cannot  take  hold 
of  objects,  and  is  often  deformed.  The  following  are  the  com- 
monest deformities  :  Hernia,  club-foot,  peculiar  shape  of  ears, 
one  or  two  toes  of  abnormal  shortness  in  each  foot,  and  wad- 
shaped  fingers ;  the  testicles  are  sometimes  absent ;  the  head 
may  be  either  large  or  small,  the  former  constituting  hydro- 
cephalic and  the  latter  microcephalic  idiocy ;  the  lips  are 
thick  and  everted,  the  mouth  large,  the  teeth  decayed ;  the 
gums  usually  swollen,  and  more  or  less  dribbling  of  saliva  from 
the  mouth. 

What  is  the  treatment  ? 

Much  may  be  accomplished  in  the  education  and  training  of 
idiots,  provided  they  are  put  in  the  hands  of  some  kind  person 
having  a  superabundance  of  patience  and  experience  ;  here  the 
idiot  will  develop  into  a  being  with  some  intelligence,  and  with 
trained  and  disciplined  habits.. 

Cretinism. 

What  is  the  definition  ? 

An  arrested  development  of  the  nervous  system  and  bodily 
organization  generally,  either  before  or  after  birth,  due  to  a 
local  cause— as  the  condition  of  the  soil,  water,  air,  etc. 

What  are  the  causes  ? 

Most  commonly  found  in  children  living  in  valleys  where 
the  air  is  foul,  the  soil  damp,  and  the  inhabitants  poor,  dirty, 
and  often  insufficiently  fed  ;  bad  drainage,  ill- ventilated  houses, 
deficient  light.     It  is  often  associated  with  goitre. 


DISEASES    OF    THE    NERVOUS    SYSTEM.  151 

What  are  the  symptoms  ? 

The  cases  of  cretinism  cease  to  grow  in  early  infancy,  there 
is  so  little  change  from  year  to  year  that  the  child  at  two  or 
three  years  looks  the  same  at  eight  or  ten.  The  skin  is  yel- 
lowish, thick,  harsh  and  wrinkled;  the  eyelids  puffy;  the 
scalp  is  scaly,  and  covered  with  a  scant  growth  of  coarse  hair ; 
the  head  is  big,  flat,  and  broad ;  the  fbntanelles  are  widely 
open,  and  sometimes  all  the  sutures  are  disjointed,  as  if  by 
hydrocephalus  ;  the  forehead  is  small  and  the  face  large ;  the 
limbs  are  large ;  the  abdomen  puffed  and  pendulous ;  the 
tongue  is  large,  and  is  frequently  carried  with  the  point  hang- 
ing out  of  the  niouth ;  the  teeth  are  cut  irregularly,  and 
are  generally  stunted  and  decayed ;  the  thyroid  is  usually 
enlarged. 

What  is  the  morbid  anatomy? 

The  bones  of  the  skull  are  thick,  the  sutures  abnormally 
obliterated.  The  cartilaginous  ends  of  the  long  bones  are 
enormously  out  of  proportion  to  the  stunted  shafts. 

What  is  the  treatment  ? 

The  child  should  at  once  be  removed  from  its  present  bad 
hygienic  surroundings  and  allowed  to  breatlie  pure  mountain 
air,  and  given  abundance  of  milk  and  a  nutritious  diet  consist- 
ing of  animal  broths,  scraped  beef,  etc.  It  should  be  given  a 
cool  sponge  bath  daily  followed  by  vigorous  frictions  of  the  skin.' 
The  syrup  of  the  iodide  of  iron  may  be  combined  with  cod-liver 
oil  in  cases  of  great  muscular  weakness.  The  oxide  and  va- 
lerianate of  zinc  are  said  to  be  of  service.  Electricity  is  useful 
where  there  is  much  wasting  of  the  limbs. 

Congestion  of  the  Brain. 

What  are  the  synonyms  ? 

Cerebral  congestion  ;  cerebral  hypera^mia. 


152  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  definition  ? 

An  abnormal  fulness  of  the  bloodvessels  of  the  brain. 

What  is  the  meaning  of  active  and  passive  congestion  ? 

Active  congestion  is  when  there  is  arterial  tulness ;  passive 
when  there  is  venous  fulness. 

What  are  the  causes  of  active  congestion  ? 

Difficult  dentition,  exposure  to  the  sun,  falls  or  blows  upon 
the  head,  excessive  excitement  and  fatigue. 

What  are  the  causes  of  passive  congestion  ? 

Anything  that  causes  an  impediment  to  the  reflux  of  the 
venous  blood  from  the  brain.  It  may  be  caused  by  the  pres- 
sure of  an  enlarged  thymus  gland,  or  the  enlargement  of  the 
cervical  or  bronchial  glands.  It  may  also  occur  in  whooping- 
cough,  and  in  children  who  are  poorly  nourished,  etc. 

What  are  the  symptoms  of  active  congestion  ? 

The  child  is  irritated  for  a  few  days  and  refuses  to  play. 
There  is  fever,  and  the  bowels  are  generally  constipated ; 
there  is  great  heat  of  the  head,  and  if  the  child  be  old  enough 
will  complain  of  headache ;  intolerance  of  light  and  sound, 
twitching  of  the  muscles  and  starting  during  sleep,  insomnia, 
gnashing  of  the  teeth.  The  pulse  is  quick  and  the  carotids 
throb.  If  these  symptoms  are  not  relieved  by  appropriate 
treatment  the  child  passes  into  a  state  of  stupor,  or  an  attack 
of  convulsions  may  occur. 

What  are  the  symptoms  of  passive  congestion  ? 

The  symptoms  are  less  suddenly  developed,  but  when  marked 
they  resemble  those  of  the  active  form. 

What  is  the  diagnosis  ? 

Between  congestion  and  apoplexy  :  In  congestion  conscious- 
ness is  seldom  entirely  abolished,  there  is  rarely  a  one-sided 
paralysis,  the  symptoms  are  brief,  and  sensation  and  motion 
are  rarely  in  one  part  simultaneously  involved. 


DISEASES    OF    THE    NERVOUS    SYSTEM.  153 

Between  embolism  and  congestion  :  In  congestion,  premoni- 
tory symptoms  ;  in  embolism,  attack  sudden.  In  congestion, 
transitory  paralysis;  in  embolism,  more  prolonged  paralysis. 
In  embolism,  usually  Lave  cardiac  disease  and  rapid  pulse  dur- 
ing attack  ;  in  congestion,  slow  pulse. 

From  epilepsy  congestion  is  marked  by  the  absence  of  a  cry, 
by  the  existence  of  premonitory  symptoms,  the  absence  of 
pallor  of  the  face,  the  rarity  and  irregularity  of  convulsions, 
and  the  absence  of  biting  of  the  tongue. 

In  uraemia  the  bodily  condition  is  important  and  condition 
of  urine  characteristic. 

What  is  the  prognosis  ? 

Mild  cases  rarely  prove  fatal.  On  the  other  hand,  if  the 
congestion  has  lasted  sufficiently  long  as  to  lead  to  serous  effu- 
sions or  to  minute  extravasations  of  blood,  the  prognosis  is  very 
grave. 

What  is  the  treatment  ? 

Cases  of  active  congestion  must  be  kept  in  a  dark  room  and 
treated  with  cathartics,  enemata,  and  calomel,  baths,  cold  ap- 
plications to  the  head  which  should  be  kept  elevated.  Full 
doses  of  bromide  of  potassium,  ergot,  or  belladonna  may  also 
be  employed. 

In  the  treatment  of  passive  congestion  attention  must  be 
given  to  the  removal  of  the  primary  cause,  which  in  many 
cases  is  impossible  to  ascertain.  The  urgent  symptoms  should 
be  at  once  treated  by  cold  applications  to  the  head,  by  revul- 
sion, and  by  careful  attention  to  the  regulation  of  the  diet  and 
condition  of  the  bowels.  If  great  danger  exists  mild  local  de- 
pletion may  be  cautiously  employed.  If  the  case  is  associated 
with  feeble  nutrition  it  may  be  necessary  to  employ  stimulants 
and  tonics  containing  quinine,  etc. 


154  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Chorea. 


What  is  the  synonym  ? 

St.  Vitus's  dance. 


What  is  the  definition? 

An  irregular,  convulsive  action  of  the  voluntary  muscles,  of 
a  clonic  kind,  especially  of  the  face  and  extremities. 

What  are  the  causes  ? 

Rarely  occurs  in  children  under  five  years  of  age.  More 
common  in  girls  than  in  boys.  Rheumatic  subjects  are  prone 
to  it.  It  may  be  reflex  from  dentition,  fright,  worms,  or  mas- 
turbation, and  is  often  hereditary. 

What  is  the  morbid  anatomy  ? 

There  is  no  one  lesion  of  constant  standing  excepting  the 
fringes  of  vegetation  which  form  on  the  edges  of  the  aoi'tic 
and  mitral  valves.  Endocarditis  is  found  in  a  great  number 
of  cases.  The  formation  of  these  vegetations  on  the  edges  of 
the  valves  has  led  to  a  direct  and  simple  pathology  for  chorea 
in  the  suggestion  that  it  is  due  to  embolism. 

What  are  the  symptoms? 

The  disease  may  either  set  in  suddenly  or  with  some  gastro- 
intestinal disorder  and  irritability  of  temper.  This  is  followed 
by  slight  twitching,  convulsive  movements  of  the  face  or  one 
of  the  lower  extremities ;  these  all  gradually  increase  in  se- 
verity, extending  to  the  other  limbs,  and  may  even  reach  the 
tongue.  The  child  cannot  walk  without  a  jerking  movement 
and  staggering  ;  the  tongue  cannot  be  protruded  without  much 
effort ;  he  cannot  stand  still,  but  constantly  fidgets  about,  and 
when  an  attempt  is  made  to  grasp  anything  he  misses  his  aim 
and  makes  his  efforts  with  strange  grimaces.  In  the  majority 
of  cases  the  movements  cease  during  sleep.  When  the  cases 
are  long  and  persistent  the  intellect  may  be  seriously  affected, 


DISEASES    OF    THE    NERVOUS    SYSTEM.  155 

and  even  in  mild  cases  it  is  usually  dulled.  The  general  health 
is  seldom  impaired,  but  constipation  is  always  present,  and 
sometimes  loss  of  appetite. 

The  specific  gravity  of  the  urine  is  increased  at  the  height 
of  an  attack  and  declines  with  the  disease.  The  heart's  ac- 
tion is  rapid  and  irregular,  and  frequently  a  low,  blowing,  sys- 
tolic murmur  is  heard  at  the  base.  When  the  movements  are 
confined  to  one  side  of  the  body  it  is  termed  hemi-chorea. 

What  is  the  duration  ? 

Usually  from  six  to  ten  weeks. 

What  is  the  diagnosis  ? 

Cannot  well  be  mistaken  for  any  other  disease. 

What  is  the  prognosis  ? 

The  majority  of  cases  recover,  although  relapses  are  frequent. 

What  is  the  treatment  ? 

The  child  must  be  put  to  bed  and  kept  perfectly  quiet. 
The  food  should  be  light  and  nutritious,  or,  better  still,  a  full 
milk  diet  with  malt  extract  may  be  employed.  If  the  mus- 
cular movements  are  very  violent  they  must  be  protected  by 
padding  the  adjacent  sides  of  the  cot,  or  in  very  severe  cases 
the  child  may  be  kept  in  a  hammock.  The  bowels  should  be 
kept  freely  opened  with  saline  laxatives,  and  if  sleep  be  dis- 
turbed some  Dover's  powder,  chloral,  or  bromide  of  potassium 
may  be  given  at  bedtime.  The  medicinal  treatment  should 
consist  of  small  doses  of  Fowler's  solution  of  arsenic,  begin- 
ning with  three  drops  three  times  a  day  for  a  child  of  six  or 
seven,  increasing  one  drop  daily  until  puffing  of  the  eyelids 
appear  showing  that  the  limit  of  toleration  has  been  reached. 
The  drug  should  then  be  withdrawn  for  a  day  or  two,  and 
afterwards  resumed,  beginning  a  little  below  the  maximum 
dose  until  a  cure  is  accom[)lished.  The  fluid  extract  of  cimi- 
cifuga  in  doses  of  five  to  twenty  drops  will  be  found  useful  in 


156  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

attacks  following  rheumatism.  Antipyrine  has  been  of  service 
in  doses  of  five  grains  three  times  daily  for  a  child  of  eight  or 
ten  years,  care  being  taken  to  watch  and  alleviate  any  depression 
produced.  The  more  sedative  drugs,  such  as  the  bromide  of 
potassium,  chloral,  belladonna,  hyoscyamus,  conium,  may  be 
employed  during  the  early  days  of  the  attack,  but  are  of  little 
value.  When  the  patient  is  able  to  be  up  and  about  the  house 
he  should  be  kept  as  quiet  as  possible,  and  restricted  from  any 
boisterous  play  or  excitement.  The  arsenic  should  be  con- 
tinued, and  if  anaemia  be  present  it  may  be  combined  with 
iron. 

^..     Liq.  Potass.  Arsenitis  f  5iss. 

Vini  Ferri  Amar.  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  three  times  daily  after  eating. 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  157 

PART   XI. 

Diseases  of  the  Organs  of  Respiration. 

Coryza. 

What  are  the  synonyms? 

Acute  nasal  catarrh  ;  cold  in  the  head  ;  "  snuffles." 

What  is  the  definition  ? 

An  acute  catarrhal  inflammation  of  the  mucous  membrane, 
lining  the  nose  and  the  cavities  communicating  with  it. 

.  What  are  the  causes  ? 

Atmospheric  change,  exposure  to  cold,  getting  the  feet  wet, 
scrofula,  and  syphilis.  Usually  present  in  the  initial  stage  of 
measles.  Irritating  gases,  dust,  and  certain  powders,  which 
excite  an  irritation  of  the  mucous  membrane.  At  times  it 
seems  to  be  contagious. 

What  are  the  symptoms? 

It  is  ushered  in  with  a  slight  fever,  snuffling  sound  in  breath- 
ing and  sneezing.  At  first  there  is  a  slight  discharge  from  the 
nostrils,  which  soon  becomes  abundant,  acrid,  and  even  muco- 
purulent. This  forms  in  crusts  about  the  nostrils,  and  greatly 
impedes  the  child's  respiration  causing  it  to  breathe  through 
the  mouth.  When  the  nasal  breathing  is  completely  obstructed 
the  child  will  be  unable  to  nurse,  and  will  be  required  to  be  fed 
with  a  spoon. 

What  is  the  duration  ? 

From  three  days  to  a  week. 

What  is  the  treatment  ? 

The  child  must  be  kept  in  one  room,  and  if  the  fever  be 
high,  in  bed.  A  little  fluid  magnesia  may  be  given  to  empty 
the  bowels,  and  the  solution  of  the  citrate  of  potassium  for  the 


158  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

fever.  At  night  bromide  of  potassium  or  chloral  should  be 
given  to  procure  sleep.  The  local  treatment  should  consist  in 
keeping  the  parts  perfectly  clean,  moist,  and  sweet.  The  crusts 
must  be  kept  moist  with  glycerine  and  the  following  anti- 
septic ointment  is  recommended  by  Goodhart  and  Starr. 

I^.     Iodoform  ^ss. 

01.  Eucalyptus  f  ^ss-f§j. 
Vaseline  q.  s.  ad  f  §ij  or  f  §iij. — M. 
Sig. 

Boracic  acid  with  glycerine  will  be  found  useful. 

;^.     Pulv.  Acid.  Boracic.  ^ss. 
Glycerinse  §j. — M. 
Sig.  Drop  two  drops  in  each  nostril  three  times  a  day. 

In  some  cases  astrigents  will  be  found  of  service  such  as 
equai  parts  of  glycerine,  and  the  glycerine  of  tannic  acid. 
In  older  children  the  nasal  douche  may  be  employed,  but  it  is 
hardly  practical  in  very  young  children. 

Acute  Simple  Laryngitis. 

What  is  the  definition  ? 

An  inflammation  of  the  mucous  membrane  lining  the 
larynx,  without  any  ulceration  or  exudation  either  of  serum 
into  the  connective  tissue  or  deposit  of  false  membrane,  and 
without  spasm. 

What  are  the  causes  ? 

Rarely  occurs  in  children.  Cold  draughts  of  air  ;  wet  feet ; 
inhalation  of  dust,  gas,  smoke,  or  ammonia;  extension  of  in- 
flammation in  erysipelas,  smallpox,  and  measles. 

What  is  the  pathological  anatomy  1 

Hypersemia  of  the  mucous  membrane  of  the  larynx,  with 
swelling  and  diminished  secretion. 


DISEASES    OF    THE    OKGANS    OF    RESPIRATION.  159 

What  are  the  symptoms  ? 

After  rigors  and  a  moderately  high  fever,  as  prodromata,  the 
symptoms  are  hoarseness,  with  burning  pain  referred  to  the 
larynx,  a  sense  of  constriction,  and  if  the  child  be  too  young  to 
express  himself,  pulls  at  his  throat  and  gasps  for  breath  ;  the 
voice  gradually  becomes  a  faint  whisper,  and  the  effort  of 
speaking  is  painful;  the  breathing  is  labored,  and  there  is 
much  difficulty  in  swallowing;  the  cough  is  spasmodic  and 
violent  when  it  occurs  ;  the  fever  at  first  runs  high,  causing 
hot  skin,  scanty  urine,  and  quick  pulse,  soon  turns  into  the 
asthenic  type,  from  the  deficient  oxygenization  of  the  blood. 
The  disease  lasts  from  three  or  four  days  to  a  week. 

What  is  the  diagnosis? 

From  laryngismus  stridulus,  by  the  presence  of  fever  and 

the  general  symptoms. 

From  croup,  by  the  absence  of  the  peculiar  croupy  noise 
and  breathing,  and  by  the  absence  of  false  membrane. 

What  is  the  prognosis  ? 

Always  favorable  in  mild  cases. 

What  is  the  treatment? 

The  child  must  be  kept  in  a  room  where  the  atmosphere 
has  been  made  moist.  Hot  and  moist  sponges  should  be  con- 
stantly kept  to  the  throat,  and  a  half  to  one-drop  doses  of  the 
tincture  of  aconite  should  be  given  in  water  every  fifteen 
minutes  until  four  doses  are  taken  ;  calomel  should  be  given  in 
broken  doses  until  the  bowels  are  freely  moved. 

I^.     Hydrarg.  Chlor.  Mil.  gr.  |. 
Sodii  Bicarb,  gr.  xij. 
Pulv.  Aromat.  gr.  vj. 
M.  et  ft.  chart.  No.  vi. 
Sig.  One  powder  every  hour. 


J  60  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

The  above  may  be  followed  by — 

^.     Tr.  Opii  Camp,  f  5j-5ij. 
Syr.  Ipecac.  f5iss-5ij. 
Sjr.  Scillse  f^ss. 
Syr.  Tolu  f§j. 

Liq.  Potass.  Citrat.  q.  s.  ad  ffiij. — M. 
Sig.  Teaspoonful  every  two  hours. 

The  diet  must  be  fluid  and  nutritious. 


Chronic  Laryngitis. 

What  is  the  definition  ? 

A  chronic  inflammation  of  the  upper  portion  of  the  larynx, 
with  thickening  of  the  mucous  membrane. 

What  are  the  causes  ? 

Usually  of  syphilitic  origin.  May  follow  membranous  laryn- 
gitis. 

What  are  the  symptoms  ? 

The  cough  is  harsh,  rough,  and  tearing  in  character ;  the 
voice  is  hoarse.  At  night  the  cough  sounds  almost  croupy  ; 
it  is  much  increased  by  the  horizontal  position,  because  the 
uvula  is  generally  relaxed  in  these  cases,  and  tickles  the  open- 
ing of  the  windpipe,  causing  a  cough,  when  the  child  is  put  to 
bed,  of  a  tearing  character,  often  lasting  for  two  or  three 
hours.     Patients  with  this  disease  are  very  susceptible  to  cold. 

What  is  the  treatment? 

The  child  must  wear  flannel  next  to  the  skin  all  the  year 
round ;  violent  exercise  should  be  avoided  ;  a  generous  diet 
should  be  given ;  the  paroxysms  of  coughing  may  be  relieved 
by  the  solution  of  morphia  in  minute  doses.  If  the  uvula  be 
relaxed  an  astringent  gargle  may  be  used,  such  as — 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  161 

^.  Acid.  Muriat.  dil.  f5j. 
Aluminis  ^iss. 
Mellis  f^j. 
Aquae  f§v. — M. 
Sig.  Gargle  every  four  hours. 

Or  it  may  be  touched  with  solid  nitrate  of  silver,  or  mopped 
with  a  solution  of  glycerine  of  tannin.  If  the  uvula  still 
remains  long  it  should  be  snipped  off  with  a  pair  of  sharp 
scissors. 

Laryngismus  Stridulus. 

What  is  the  synonym  ? 

Spasm  of  the  glottis. 

What  is  the  definition  ?  - 

A  spasm  of  the  muscles  of  the  larynx,  without  inflammation, 
cough  or  fever,  characterized  by  a  sudden  development  of 
dyspnoea. 

What  are  the  causes? 

Reflex  irritation  from  the  teeth,  stomach,  and  bowels.     Rare 

after  twelve  months. 

What  is  the  pathological  anatomy? 

Death  is  so  rare  that  the  changes  in  the  larynx  are  not 
clearly  understood. 

What  are  the  symptoms  ? 

The  invasion  of  the  disease  is  sudden,  and  often  comes  on 
durin^T  sleep.  Sometimes  certain  prodromata  may  be  observed, 
as  the  twitching  of  the  thumb  into  the  palm  of  the  hand,  a  pecu- 
liar movement  of  the  muscles  of  the  mouth,  and  slight  facial 
twitches.  After  these  symptoms  the  paroxysm  appears,  when 
the  head  is  thrown  back,  the  nostrils  are  dilated,  the  veins  of  the 
head  and  neck  distended,  the  eyes  staring,  and  convulsive 
movements  of  the  muscles  of  inspiration.  This  may  last  from 
11 


162  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

a  few  seconds  to  nearly  three-quarters  of  a  minute,  during 
which  asphyxia  seems  imminent,  when  suddenly  the  closed 
glottis  relaxes  and  inspiration  takes  place  with  a  loud,  crowing 
sound,  which  gives  the  name  to  the  disease.  These  attacks 
may  end  in  convulsions. 

What  is  the  diagnosis? 

From  croup.  In  laryngismus  there  is  no  cough,  fever,  or 
sign  of  inflammation.  The  attack  is  sudden,  as  well  as  the  re- 
covery ;  there  is  no  false  membrane ;  croup  seldom  recurs, 
while  laryngismus  does. 

From  acute  laryngitis,  which  is  rare  in  infants,  is  gradual  in 
attack,  steady  in  symptoms,  and  causes  fever  and  quickened 
respiration. 

What  is  the  prognosis  ? 

Favorable.     Death  may  occur  from  suffocation  in  very  young 

children,  but  is  rare. 

What  is  the  treatment? 

The  first  indication  is  to  remove  the  cause.  Lance  the  gums 
when  from  teething ;  clear  out  the  bowel  and  stomach  when  it 
is  gastric  or  intestinal.  If  prodromata  occur  the  child  should 
be  given  a  mustard  foot-bath  and  cold  applied  to  the  head.  For 
the  actual  fit  the  inhalation  of  a  few  drops  of  chloroform,  care 
being  taken  not  to  cause  complete  anaesthesia.  This  should  be 
followed  by  full  doses  of  the  bromide  of  potassium  or  sodium 
combined  with  chloral.  Hot  alternating  with  cold  packs  should 
be  constantly  kept  to  the  throat.  The  following  formula  will 
be  found  useful : — 

^.     Potass.  Brom., 

Sodii  Brom.  aa  5J« 
Chi  oralis  gr.  xlviij. 
Syr.  Simp.  f^j. 

Aquse  Cinnam.  q.  s.  ad  f^iij. — M. 
Sig.  Teaspoonful  every  half  or  hour  as  required. 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  163 

After  the  paroxysm  the  bromide  of  potassium  mixture  with- 
out the  chloral  should  be  continued.  The  child's  diet  must 
be  looked  after  and  the  most  nourishing  food  given. 

Spasmodic  Laryngitis. 

What  are  the  synonyms  ? 

False  croup  ;  child  crowing. 

What  is  the  definition  ? 

A  catarrhal  inflammation,  without  pseudo-membranous  exu- 
dation, of  the  mucous  membrane  of  the  larynx,  attended  with 
spasmodic  contraction  of  the  glottis,  occasioning  violent  attacks 
of  threatened  suffocation. 

What  are  the  causes  ? 

Occurs  most  frequently  during  the  first  dentition,  being  very 
common  during  the  second  year  of  life,  though  it  is  often  met 
with  a  year  or  two  later.  It  is  more  frequent  in  boys  than  in 
girls.  It  is  hereditary  in  some  families.  Atmospheric  change 
and  enlarged  tonsils  are  the  most  frequent  causes. 

What  are  the  symptoms? 

Tlie  child  goes  to  bed  with  a  slight  cold,  and  is  probably 
feverish  and  a  little  hoarseness  is  present.  In  a  few  hours  he 
awakes  with  more  or  less  spasmodic,  noisy  dyspnoea,  threaten- 
ing suffocation,  much  hoarseness,  and  a  harsh  cough.  In  an 
hour  or  two  the  breathing  becomes  easier,  the  cough  softer,  and 
the  child  falls  asleep.  The  next  morning  he  may  have  a  loose 
cough,  but  the  respiration  will  be  about  normal. 

What  is  the  diagnosis  ? 

The  symptoms  are  so  characteristic  there  is  little  difficulty 
in  the  diagnosis. 

What  is  the  prognosis  ? 

Always  favorable  ;  fatal  cases  are  rare. 


164  ESSENTIALS    OF    DISEASES    OF    CHILDKEN. 

What  is  the  treatment  ? 

During  the  paroxysm  the  child  must  be  placed  in  a  hot 
bath  or  hot  fomentations  should  be  kept  about  his  throat  and 
chest.  Fifteen  drops  of  the  syrup  of  ipecacuanha  should  be  ad- 
ministered every  ten  minutes  until  emesis  is  produced.  Da 
Costa  recommends  the  hypodermic  injection  of  apomorphia  in 
one-fortieth  of  a  grain  dose.  After  vomiting  has  been  secured, 
bromide  of  potassium  should  be  given  and  a  simple  expectorant 
for  the  cough. 

^.     Syr.  Ipecac,  f  5iss 
Tr.  Opii  Camp,  f  5ij- 
Syr.  Scillse  f  §j. 
'  Liq.  Potass.  Citrat.  q.  s.  ad  f  ^iij. — M. 

Sig.  Teaspoonful  every  two  hours. 

Children  who  have  repeated  attacks  of  croup  are  very  sus- 
ceptible to  cold,  and  very  little  exposure  is  sufficient  to  produce 
one  of  these  attacks ;  consequently  the  child  should  be  clothed 
with  thin  flannel  in  summer  and  thick  in  winter.  Long  stock- 
ings should  be  used,  and  stout  shoes  to  keep  the  feet  perfectly 
dry. 

Acute  Membranous  Laryngitis. 

What  are  the  synonyms? 

Pseudo-membranous   laryngitis ;    membranous  croup ;    true 

croup. 

What  is  the  definition? 

An  acute  inflammation  of  the  mucous  membrane  of  the 
larynx,  attended  with  the  exudation  of  false  membrane. 

What  are  the  causes  ? 

Cold  and  moisture.  It  is  prone  to  aflTect  certain  families. 
More  prevalent  in  winter  and  spring.  Usually  occurs  in  robust 
males. 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  1G5 

What  is  the  pathological  anatomy  ? 

The  mucous  membrane  of  the  larynx  and  trachea  is  inflamed, 
red,  and  vascular,  being  much  thickened,  and  peals  off  easily. 
Microscopically  this  consists  of  cells  lying  in  finely  fibrillated 
substances.  It  is  a  layer  of  lymph  varying  in  thickness,  white 
or  yellow  in  color  lining  the  larynx  and  trachea,  and  in  some 
cases  extending  down  into  the  bronchi.  This  false  membrane 
may  be  formed  in  patches  or  in  cylindrical  pieces,  or  present 
perfect  casts  of  the  tubes.  Its  free  surface  is  smooth  and 
glazed  with  muco-puriform  matter,  and  is  thinner  in  the 
larynx  than  in  the  trachea,  and  thinnest  in  the  bronchial  tubes. 
The  bronchi  show  slight  traces  of  inflammation.  Lobar  and 
lobular  pneumonia  often  exist,  and  vesicular  emphysema  is 
generally  present  at  some  portion  of  the  lung.  The  right  side 
of  the  heart  is  generally  gorged  with  dark  blood.  Congestion 
may  exist  in  the  brain,  liver,  spleen,  and  kidneys. 

What  are  the  symptoms? 

The  onset  of  this  disease  is  usually  slow.  Laryngeal  symp- 
toms, with  fever  and  hoarseness,  last  for  a  few  days.  The 
symptoms  are  worse  at  night.  The  child  is  languid  and 
fretful,  refusing  to  take  food.  The  cough  gradually  becomes 
smothered  and  paroxysmal;  the  inspiration  is  hissing  and 
jerking,  and  later  the  expiration  is  affected  in  the  same  way. 
The  fever  now  is  increased,  the  thirst  is  intense,  and  the 
tongue  furred;  the  child  is  restless  and  constantly  strugglino- 
for  breath.  At  first  between  the  paroxysms  he  may  drop  into 
an  unquiet  sleep  from  exhaustion  ;  but  later  on  the  fits  are 
almost  incessant  and  there  is  no  time  for  sleep.  The  face  is 
most  anxious,  the  eyes  glassy,  the  lips  livid,  and  clammy  per- 
spiration begins  to  appear.  The  child  throw's  back  its  head  to 
increase  the  size  and  capacity  of  the  trachea  to  receive  air, 
and  grasps  at  its  throat.  Violent  vomitinor  or  couo-hino-  may 
frequently  remove  a  portion  of  the  membrane  and  give  relief. 


166  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

The  symptoms  then  subside ;  the  pulse  becomes  slower  and 
stronger ;  the  skin  cools,  and  the  child  may  recover.  In  some 
cases,  however,  this  condition  is  only  a  truce  ;  the  membranes 
re-deposit  thicker  and  firmer  than  before ;  the  child  becomes 
exhausted ;  respiration  is  stertorous ;  the  respiratory  murmur 
is  lost,  and  coma  and  death  ensue.  In  those  cases  in  which  the 
membrane  is  not  reformed,  recovery  is  slow ;  portions  of  false 
membrane,  pus,  and  mucus,  are  coughed  up,  and  the  cough 
and  voice  remain  altered  for  some  time. 

What  is  the  duration  ? 

About  one  week. 

What  is  the  diagnosis  ? 

From  simple  acute  laryngitis  the  diagnosis  is  sometimes 
very  difficult.  It  is  only  certain  when  the  deposit  is  seen  in 
the  larynx,  or  when  a  portion  of  false  membrane  is  coughed 
up  or  dislodged  by  vomiting.  Alum  used  as  an  emetic  may 
coagulate  mucus,  and  give  rise  to  a  false  diagnosis  of  croup, 
when  the  disease  is  simple  laryngitis.  Distinguished  from 
spasmodic  laryngitis  the  history,  prodromes,  whispering  or  ex- 
tinction of  voice,  and  smothered  cough,  presence  of  fever,  and 
duration  of  many  days. 

Spasmodic  croup  has  few  or  no  prodromes,  sudden  onset, 
distinct  paroxysms  on  successive  nights  with  intermissions, 
hoarse  and  shrill  voice,  ringing  cough,  wheezing  breathing,  in 
paroxysms  only,  expulsion  of  mucus,  only  sliglit  or  no  fever, 
and  duration  seldom  more  than  a  few  hours. 

What  is  the  prognosis  ? 

Under  the  age  of  seven  years  recovery  is  the  exception. 

What  is  the  treatment? 

The  child  must  be  put  to  bed  in  a  room  that  is  well  warmed 
and  the  atmosphere  kept  moist  by  a  kettle  of  water  constantly 
boiling.     An  emetic  should  be  given  at  once ;  either  a  teaspoon- 


DISEASES    OP    THE    ORGANS    OF    RESPIRATION.  167 

ful  of  the  wine  of  ipecacuanhas  or  powdered  alum  in  drachm 
doses  mixed  with  syrup  of  honey.  The  hypodermic  injection 
of  apomorphia  (gr.  J,)  is  another  very  certain  method  but 
rather  depressing  in  its  action.  If  the  patient  is  seen  early 
half-drop  doses  of  the  tincture  of  aconite  every  fifteen  minutes 
until  four  doses  are  given.  Quinine  should  be  given  to  support 
the  general  system.  Bromide  of  ammonium  in  full  doses  will 
also  be  found  useful  alternated  with  the  quinine  every  three 
hours.  Mercury  is  probably  one  of  the  most  reliable  drugs 
we  have  for  this  disease.  The  following  formula  will  be  found 
reliable : — 

^.     Hydrarg.  Chlor.  Mit.  gr.  ij. 

Sodii  Bicarb,  gr.  xxiv. 

Pulv.  Ipecac,  gr.  j. 

Pulv.  Pepsinae  gr.  xxiv. 
M.  et  ft.  chart.  No.  xii. 
Sig.  One  powder  every  two  hours. 

Morrell  Mackenzie  recommends  the  following  spray  to  dis- 
solve false  membrane  : — 

^.     Acid.  Lactic.  5iiiss. 

Aquae  Destillat.  f  ^x. — M. 
Sig.  Apply  frequently  with  spray  or  mop. 

The  inhalation  of  the  vapor  of  slaked  lime  is  very  efficient 
in  detaching  the  false  membrane.  The  child's  strengtli  must  be 
maintained  by  full  doses  of  alcoholic  stimulant,  milk  and  animal 
broths. 

If  the  exudation  increases  and  there  is  imminent  danger  of 
suffocation,  intubation  or  tracheotomy  must  be  resorted  to. 

Acute  Bronchitis. 

What  are  the  synonyms? 

lironchial  catarrh  ;  cold  on  the  chest. 


168  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  is  the  definition  ? 

An  acute   catarrhal  inflammation  of  the   larger  bronchial 

tubes. 

What  are  the  causes  ? 

Common  in  infants  during  the  period  of  teething.  Cold  and 
moisture  ;  inhalations  of  irritants,  as  dust,  smoke,  etc. 

What  is  the  pathological  anatomy? 

Hjperaimia  of  the  mucous  membrane  of  the  bronchial  tubes  ; 
there  is  generally  some  thickening  and  softening  of  the  mucous 
membrane,  which  is  covered  with  a  muco-purulent  secretion. 

What  are  the  symptoms  ? 

The  respirations  are  hurried  ;  rigors  and  fever  ;  temperature 
of  102°  or  103°  F.  ;  cough,  furred  tongue,  pain  and  tightness 
in  the  throat ;  the  cough,  which  at  fii-st  is  hard,  becomes  in  a 
day  or  two  looser,  and  in  infants  especially  this  greatly  in- 
creases dyspnoea,  because  they  are  unable  to  expel  the  phlegm. 
There  may  be  slight  delirium,  and  in  young  children  the  at- 
tack is  often  ushered  in  with  a  convulsion. 

What  is  the  character  of  percussion? 
Normal  in  uncomplicated  cases. 

What  is  the  auscultation  ? 

In  the  beginning  of  the  attack  the  respiratory  murmur  is 
harsh  and  sonorous,  mucous  and  sibilant  rales  are  heard.  All 
sounds  may  be  temporarily  suppressed  by  a  plug  of  mucus. pre- 
venting access'  of  air  to  a  portion  of  the  lung.  Coughing  will 
remove  the  obstruction  and  develop  the  rales. 

In  the  later  stage,  the  secretion  being  increased,  the  respira- 
tion is  not  so  harsh  in  character,  and  is  associated  with  large 
and  small  bubbling  rales. 

What  is  the  diagnosis? 

The  mild  form  is  not  likely  to  be  mistaken  for  anything  but 

the  early  stage  of  whooping-cough. 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  1G9 

What  is  the  prognosis  ? 

Simple  acute  bronchitis  is  rarely  fatal  excepting  in  very 
young  infants. 

What  is  the  treatment  ? 

The  child  should  be  kept  in  bed  and  the  air  of  the  room 
must  be  moistened.  The  chest  should  be  enveloped  in  a  cotton 
jacket  and  rubbed  twice  daily  with  the  following  : — 

^.     01.  Camphorat.  f^iv. 
Sig. 

Or, 


^.     Spt.  Terebinth,  f^j. 
01.  Olivse  f^iv.— M. 


Sis. 


The  food  should  be  light  but  nutritious,  consisting  chiefly  of 
milk  and  broths.  The  following  mixture  may  be  given  at  the 
beginning  of  the  attack  : — 

EJ.     Liq.  Potass.  Citrat.  f^iij* 
Sig.  Teaspoonful  in  water  every  two  hours. 

When  the  fever  subsides  the  following  may  be  given  : — 

^.     Ammon.  Chlor.  gr.  xxxvj. 
Syr.  Ipecac.  15iss. 
Syr.  Scillse  f^ss. 
Syr.  Tolu  f^j. 

Aquae  Menthae  Pip.  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  three  years. 

If  the  child  be  greatly  prostrated,  carbonate  of  ammonium, 
alcohol,  or  quinine  should  be  administered;  the  latter,  in  young 
infants,  is  best  given  by  suppository. 

Chronic  Bronchitis. 

What  in  the  definition  ? 

A  chronic  inflammation  of  the  mucous  membrane  of  the  bron- 
chial tubes. 


170  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  are  the  causes  ? 

Sometimes  a  result  of  an  acute  attack  ;  exposure  to  cold  and 
wet,  etc.     Frequently  follows  whooping-cough. 

What  are  the  symptoms  ? 

A  child  suffering  from  chronic  bronchitis  is  usually  short  of 
breath  ;  the  chest  is  deep  and  flattened  from  side  to  side,  with 
a  prominent  sternum.  The  finger-ends  are  clubbed,  and  there 
is  a  frequent,  moist,  short  cough. 

What  is  the  percussion  note? 
Normal  in  uncomplicated  cases. 

What  is  the  auscultation  ? 

The  chest  is  full  of  moist  rales,  both  large  and  small.  The 
inspiratory  murmur  is  shortened  and  somewhat  labored. 

What  is  the  prognosis  ? 

Uncomplicated  cases  usually  recover  under  proper  treatment. 

What  is  the  treatment  ? 

Much  the  same  as  in  acute  attacks.  The  child  sliould  wear 
flannel  next  to  the  skin  all  the  year  round,  and  be  exposed  as 
little  as  possible  to  atmospheric  changes.  The  diet  should  be 
nutritious,  consisting  of  clear  soups,  animal  broths,  raw  beef- 
juice,  rare  beef  scraped  or  finely  minced,  milk  punch,  etc. 
Expectoration  is  best  promoted  by  the  use  of  alkalies.  In  the 
later  stage,  when  the  expectoration  is  profuse,  Goodhart  and 
Starr  recommend  the  following  : — 

^.     Acid.  Gallic,  gr.  x. 
Vini  Opii  ttiv. 
Spt.  Vini  Grallici  f  5iss. 
Aquae  Chloroform  q.  s.  ad  f  f  iss. — M. 
Sig.  Teaspoonful  three  times  a  day. 

^.     Alum  5ss. 

Vini  Ipecac,  f  5iss. 
Sjr.  Tola  f  ^ss. 
Aquae  q.  s.  ad  f  ^iij. — M. 
Sig.  One  or  two  teaspooufuls  every  three  hours. 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  171 

The  back  and  sides  of  the  chest  should  be  rubbed  vigorously 
night  and  morning  with  a  simple  liniment.  Quinine  may  be 
given  in  half-grain  doses  three  times  a  day. 

^.     Quinise  Sulphat.  gr.  vj. 

Acid.  Sulphuric,  dil.  gtt.  xij. 
Syr.  Simp,  f  fss. 
Aquse  q.  s.  ad  f  §iij. — M. 
Sig.  Teaspoonful  every  two  hours.  (Meigs  and  Pepper.) 

During  this  stage  of  the  disease  tonics  containing  iron,  such 
as  the  ferrated  tincture  of  cinchona,  are  useful.  Some  prepa- 
ration of  malt  combined  with  cod-liver  oil  is  valuable  to  im- 
prove the  general  health. 

Capillary  Bronchitis.  . 

What  is  the  synonym? 
Suffocative  catarrh. 

What  is  the  definition  ? 

An  acute  catarrhal  inflammation  of  the  smaller  bronchial 
tubes,  occurring  principally  in  children. 

What  are  the  causes  ? 

Exposure  to  cold,  any  sudden  change  of  temperature.  Fre- 
quently complicates  the  exanthemata. 

What  is  the  pathological  anatomy  ? 

Inflammation  and  redness  of  the  lining  membrane  of  the 
bronchioles ;  the  affected  tubes  are  dilated  and  filled  with 
tenacious  mucus  and  pus ;  the  air  vesicles,  which  are  least 
obstructed,  are  dilated  and  emphysematous.  If  the  secretion 
completely  closes  any  of  the  smaller  tubes,  the  air  previously 
drawn  into  the  vesicles  will  be  absorbed,  causing  collapse. 

When  the  inflammation  reaches  the  alveoli  of  the  lungs  it 
causes  broncho-pneumonia. 


172  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  are  the  symptoms? 

The  pulse  is  high  (120-180);  temperature  from  102°  to 
104°,  with  gradually  increasing  apnoea ;  respiration  is  very 
frequent,  varying  from  60  to  80  to  the  minute,  and  is  whistling 
and  labored  ;  the  jugular  veins  are  prominent ;  the  blood  is 
not  properly  asrated ;  the  face  is  cyanozed  and  the  lips  livid ; 
the  cough  is  vioient  and  paroxysmal,  causing  great  substernal 
pain ;  the  sputa,  which,  by  the  way,  is  absent  during  the  first 
two  or  three  days,  appears  about  the  third  day,  consisting  of 
purulent,  tenacious  mucus,  sometimes  streaked  with  blood,  and 
often  complete  casts  of  the  smaller  bronchioles  are  ejected. 

What  is  the  character  of  percussion  ? 

Normal,  except  over  the  portions  of  the  lungs  that  are  col- 
lapsed, when  dulness  rapidly  develops. 

What  is  the  auscultation  ? 

The  breathing  is  harsh  during  the  first  few  days,  when  it  is 
followed  by  a  diminished  respiratory  murmur  with  subcrepitant 
rales. 

What  is  the  diagnosis? 

The  livid  expression  of  the  child's  face ;  frequent  and 
labored  respiration ;  violent  and  paroxysmal  coughing  spells ; 
diminished  respiratory  murmur  with  subcrepitant  rales. 

What  is  the  prognosis? 

Very  grave. 

What  is  the  treatment? 

From  the  beginning  of  the  attack  the  child  must  be  kept  in 
a  room  with  an  even  temperature,  with  the  air  moistened  by 
steam.  The  chest  should  be  enveloped  in  a  cotton  jacket  or 
poultice,  and  should  be  rubbed  night  and  morning  with  the 
turpentine  and  oil  mixture  mentioned  under  Acute  Bronchitis. 

The  diet  should  consist  of  milk,  animal  broths,  raw  beef 
juice — the  latter  in  teaspoonful  doses  every  three  or  four  hours— 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  173 

and  stimulants.  Quinine  should  be  given  in  full  doses,  either 
by  the  mouth  or  rectum.  For  the  cough,  any  cf  the  mixtures 
recommended  under  Acute  Bronchitis  will  be  found  useful,  or 
the  following  : — 

]^.     Ammon.  Carboiiat.  gr.  xxiv. 
Syr.  Tolu  f  5vj. 
Spt.  Vini  Gallic!  f5iij. 
Syr.  Senegse  f  5iiiss. 
Syr.  Acacise  q.  s.  ad  f  fiij. — M. 
Sig.  Teaspoonful  every  two  hours. 

Should  the  child  become  suifocated  emetics  must  be  at  once 
administered;  either  the  syrup  of  ipecacuanha,  alum,  or  the 
sulphate  of  zinc  may  be  used. 

Catarrhal  Pneumonia. 

What  are  the  synonyms? 

Lobular  pneumonia  ;  broncho-pneumonia. 

"What  is  the  definition? 

An  acute  catarrhal    inflammation  of   the  bronchioles  and 

alveoli  of  the  lungs. 

What  are  the  causes? 

From  extension  of  an  old  bronchial  catarrh ;  frequently 
follows  measles  and  whooping-cough  ;  exposure.  Rickety  and 
scrofulous  children  are  prone  to  this  disease. 

What  is  the  pathological  anatomy  ? 

Inflammation  of  the  mucous  membrane  of  the  bronchi  and 
bronchioles  including  the  air  cells.  The  tissues  are  swollen 
and  there  is  an  abnormal  secretion,  and  a  production  of  young 
cells  from  the  proliferation  of  the  bronchial  epithelium,  admixed 
with  a  yellowish  mucous  material  which  blocks  up  the  bron- 
chioles and  air  cells. 

The  parts  affected  are  at  first  of  a  reddish-gray,  changing 


174  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

to  a  yellowish -gray  color,  due  to  tlie  inetamorphosis  of  the  newly 
developed  cells.  If  the  fatty  change  be  complete,  absorption 
takes  place,  thus  removing  the  consolidation  ;  if  it  remains  in- 
complete the  cells  atrophy,  and  the  disease  passes  into  a  chronic 
state.  The  walls  of  the  bronchial  tubes  often  become  thickened 
and  their  calibre  dilated. 

Wliat  are  the  symptoms? 

Those  first  observed  are  restlessness  and  slight  fever,  which 
increase  in  severity  toward  night,  then  a  cough  is  developed 
with  rapid  breathing,  great  heat  of  skin,  102°-104°Fc,  vomit- 
ing, loss  of  appetite,  thirst,  and  a  furred  tongue,  red  at  the  tip 
and  edges.  If  the  child  be  at  the  breast,  the  hurried  breathinoj 
prevents  it  from  sucking  properly.  Sometimes  the  attack  is 
more  sudden,  the  child  awakes  in  the  night  with  a  hot  skin 
and  rapid  pulse,  flushed  face  and  a  severe  cough.  This  form 
is  more  common  in  older  children.  When  the  dyspnoea  is  very 
great  the  nostrils  work  and  dilate. 

The  inspiration  is  short  and  the  expiration  prolonged  and 
noisy;  the  pulse  varies  from  150-160,  and  the  breathing 
from  60—80  per  minute.  The  expectoration  is  muco-purulent, 
the  urine  is  scanty  and  high  colored,  and  the  surface  of  the 
body  is  frequently  covered  with  perspiration.  In  feeble  chil- 
dren this  disease  may  prove  fatal  in  a  few  days. 

What  is  the  percussion  note  ? 

Dulness  is  found  in  patches  over  both  lungs,  the  intervening 
healthy  points  giving  a  more  or  less  tympanitic  note. 

What  is  the  auscultation  ? 

The  breathing  at  first  is  vesiculo-bronchial,  associated  with 
small  subcrepitant  rdles.  As  the  disease  progresses  the  rdles 
become  larger  and  more  copious. 

What  is  the  diagnosis  ? 

From  bronchitis  it  is  to  be  diagnosed  by  the  higher  tern- 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  175 

perature,  the  breathing  less  labored,  dulness  on  percussion, 
subcrepitant  rales,  and  increased  vocal  fremitus  when  the  sign 
can  be  obtained.  From  pleurisy,  vocal  fremitus  diminished, 
the  cough  is  drier ;  percussion  dulness  varies  with  the  position 
of  the  child.     Pleurisy  is  rare  under  six  years. 

What  is  the  prognosis? 

Very  fatal  in  scrofulous  and  rachitic  children. 

What  is  the  treatment  ? 

The  child  must  be  placed  in  a  warm  bed,  in  a  well-venti- 
lated room.  It  should  be  clothed  in  flannel,  and  the  chest 
enveloped  either  in  a  cotton  jacket  or  poultice.  Tlie  chest 
and  back  may  be  rubbed  night  and  morning  with  turpentine 
and  sweet  oil  or  camphorated  oil,  care  being  taken  to  prevent 
exposure  of  the  parts  during  this  process.  The  patient  must 
be  kept  on  a  liquid  diet  consisting  of  milk,  animal  or  clam 
broth,  and  raw  beef  juice.  Internally  the  solution  of  the  citrate 
of  potassium  may  be  given  in  drachm  doses  to  a  child  of  one 
year  every  two  or  three  hours  until  the  cough  becomes  loose, 
then  the  following  : — 

5.     Ammon.  Chlor., 

Ammon.  lodid.  aa  gr.  xxiv. 
Syr.  Scillse  f§ss. 
Syr.  Toll!  f  ^j. 
Aquse  q.  s.  ad  ffiij. — M. 
Sig.  Teaspoonful  every  three  hours  for  a  child  of  two  years. 

Quinine  may  be  administered  by  suppository.  Should  the 
fever  continue  high  a  course  of  the  tincture  of  aconite  may  be 
used  or  minute  doses  of  antipyrine,  care  being  taken  to  combat 
any  depression  caused  by  the  latter  drug.  For  pleuritic  pain  in 
children  of  six  to  eight  years,  a  two  grain  dose  of  Dover's 
powder  may  be  given.  Brandy  and  whiskey  should  be  used  as 
required.  During  convalescence  the  syrup  of  the  iodide  of 
iron  with  malt  or  cod-liver  oil  should  be  used. 


176  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Croupous  Pneumonia. 

What  are  the  synonyms? 

Lobar  pneumonia ;  fibrinous  pneumonia. 

What  is  the  definition  ? 

An   acute   croupous    inflammation    involving  the  vesicular 

structure  of  the  lungs. 

What  are  the  causes? 

It  is  not  common  in  winter.  Common  in  children  after  the 
third  year.  It  often  occurs  epidemically,  the  result  of  atmos- 
pheric changes;  exposure  to  draughts  and  cold  are  potent 
causes. 

What  is  the  pathological  anatomy  ? 

The  first  stage  is  that  of  inflammatory  enlargement  of  an 
extended  portion  of  lung ;  the  vessels  are  full ;  the  capillaries 
are  distended,  pressing  on  the  air  space  in  the  sacs.  In  the 
second  stage  the  engorged  vessels  relieve  themselves  by  pour- 
ino-  out  liquor  sanguinis  and  some  corpuscular  elements  into 
the  air  sacs,  wiiich  become  blocked  with  fibrine,  and  a  con- 
dition known  as  hepatization  is  the  result.  In  a  later  stage 
grey  hepatization  is  present,  the  lighter  color  being  due  to  a 
greater  number  of  corpuscular  elements  being  present. 

What  are  the  symptoms? 

The  onset  is  sudden.  There  is  high  fever,  dyspnoea,  rapid 
pulse,  headache,  pain  in  the  side,  short  cough,  and  in  some 
cases  vomiting  and  diarrhoea.  In  children  under  three  years 
convulsions  are  not  uncommon  at  the  onset,  but  are  rare  in 
older  children  ;  the  convulsions  may  prove  fatal  before  the 
attack  of  pneumonia  has  fully  developed.  Delirium  may  be 
one  of  the  early  symptoms  if  the  temperature  is  very  high. 
The  cheeks  are  flushed^  the  alse  nasi  are  working,  the  respira- 
tions may  be  40  to  the  minute  or  more,  the  pulse  120  to  140, 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  177 

temperature  in  the  neighborhood  of  104°  F. ;  the  tongue  is 
dry  and  brown,  and  there  may  be  herpes  about  the  mouth. 
The  urine  is  dark  in  color,  the  cough  is  dry  and  hacking, 
accompanied  by  pain  during  the  act ;  the  sputa  is  rusty  in 
color;  the  fever  and  dyspnoea  continue,  the  cliild  remaining 
very  ill  till  the  end  of  a  week,  when,  usually  between  the  sixth 
and  ninth  day,  the  fever  suddenly  abates,  and  a  marked  im- 
provement takes  place  in  all  the  symptoms,  so  that  it  is  evident 
the  crisis  has  come. 

What  are  the  physical  signs  ? 

Palpation,  First  stage  :  Vocal  fremitus  more  distinct  than 
normal. 

Second  stage :  Vocal  fremitus  very  much  exaggerated. 

Percussion.     First  stage  :  Slightly  impaired. 

Second  stage  :  Dulness  over  affected  parts.  The  left  base 
and  right  apex  are  favorite  spots  to  be  attacked. 

Auscultation.  First  stage  :  Feeble  vesicular  breathing,  asso- 
ciated with  crepitant  rales,  are  heard  over  the  affected  part, 
being  more  distinct  during  inspiration. 

Second  stage  :   Harsh,  bronchial  breathing  ;  bronchophony. 

Third  stage :  The  bronchial  breathing  changes  to  vesiculo- 
bronchial, and  the  crepitant  rales  return.  During  the  process 
of  resolution  the  breath-sounds  are  associated  with  large  and 
small,  moist,  bubbling  rales. 

What  is  the  diagnosis  ? 

Croupous  pneumonia  rarely  occurs  under  the  age  of  three 
years.  The  physical  signs — dulness  on  percussion,  bronchial 
respiration,  bronchophony,  and  vocal  fremitus — will  aid  in  the 
diagnosis. 

What  is  the  prognosis? 

Favorable,  when  it  attacks  healthy  children  over  three  years 
of  age. 

12 


178  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  are  the  complications? 

Pleurisy  frequently  accompanies  croupous  pneumonia,  which 
is  apt  to  become  suppurative  in  delicate  children.  Pericar- 
ditis sometimes  occurs.  Meningitis  is  rare,  although  it  occa- 
sionally occurs.     Diphtheria  may  complicate  it. 

What  is  the  treatment  ? 
See  Catarrhal  Pneumonia. 

Atelectasis. 

What  is  the  definition  ? 

A  disease  in  which  the  lung  either  remains  in  a  foetal  con- 
dition or  returns  to  a  state  of  non-expansion. 

What  are  the  causes  ? 

Anything  which  prevents  the  expansion  of  a  lung,  either  in 
whole  or  part,  will  lead  to  collapse. 

What  are  the  symptoms  ? 

When  this  atlection  occurs  during  the  first  few  weeks  of  life 
the  child  is  wasted  and  pinched,  with  a  very  weak  cry.  The 
movements  of  the  chest  are  shallow ;  the  child  shows  difficulty 
in  sucking,  and  the  pulse  is  weak.  The  most  frequent  seat  of 
the  trouble  is  the  inferior  and  posterior  portions  of  the  right 
lunof. 

What  is  the  morbid  antomy  ? 

The  lung  is  dark-red  in  color,  without  crepitation,  exuding 
no  bubbles,  but  sanguineous  serum  ;  it  sinks  in  water. 

What  is  the  diagnosis  ? 

The  previous  history  is  particularly  important,  since,  in  all 
such  cases,  it  will  be  found  that  the  infant  was  either  stillborn 
and  resuscitated  with  more  or  less  difficulty,  or  that  it  was  born 
weak  and  feeble,  and  that  the  respiration  had  never  been  com- 
pletely established. 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  179 

What  is  the  prognosis  ? 
Usually  grave. 

What  is  the  treatment? 

If  there  be  much  accumulation  of  mucus  in  the  broncljial 
tubes  an  emetic  must  be  given.  Expectoration  should  be 
encouraged  by  alkaline  remedies,  as  the  bicarbonate  of  potas- 
sium, and  by  stimulating  expectorants,  as  carbonate  of  ammo- 
nium and  squills.  The  child  should  be  kept  in  bed  in  a  room 
of  an  even  temperature,  with  the  atmosphere  kept  moistened 
by  steam.  The  child's  clothing  should  consist  of  flannel. 
If  the  stomach  will  stand  it,  quinine,  iron,  and  cod-liver  oil 
must  be  given.  Stimulants,  such  as  brandy  or  whiskey,  should 
be  constantly  employed  to  keep  up  the  strength  and  bodily 
temperature. 

Tubercular  Phthisis. 

What  are  the  synonyms  ? 

Tuberculosis ;  incipient  phthisis. 

What  is  the  definition  ? 

The  deposition  of  tubercles  in  the  structure  of  the  lung, 
which  undergoes  softening,  causing  more  or  less  loss  of  the 
pulmonary  tissue. 

What  are  the  causes  ? 

Hereditary  in  the  majority  of  cases ;  it  is  associated  with 
scrofula — said  to  be  contagious  under  certain  conditions ;  may 
be  secondary  to  catarrhal  pneumonia ;  bacillus  tuberculosis. 

What  is  the  pathological  anatomy  ? 

The  individual  granules  of  miliary  tubercle  vary  much  in 
size,  and  are  sometimes  so  minute  as  to  escape  detection  upon 
superficial  examination. 

The  distribution  of  tubercular  disease  is  more  irreo^ular  in 
the  lungs  of  children  than  in  adults.     It  is  much  more  fre- 


180  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

quentlj  found  to  be  distributed  throughout  the  lung  than  at 
the  apex. 

Cheesy  bronchial  glands  of  considerable  size  are  far  more 
common  in  children  than  in  adults. 

What  are  the  symptoms? 

The  disease  commences  insidiously;  the  child  is  weak  and 
wretched,  constantly  fretting  and  complaining  of  pains  all  over 
the  body.  A  little,  hacking  cough  appears,  with  scanty  expec- 
toration. There  is  no  haemoptysis,  and  seldom  diarrhoea,  and 
only  occasionally  profuse  sweats.  The  dyspnoea  is  more  dis- 
tressing in  children  than  in  adults,  and  the  fever  higher  and 
wasting  more  rapid.  The  bowels  are  irregular,  alternating 
often  from  constipation  to  diarrhoea,  and  the  stools  are  com- 
monly clay-colored. 

The  skin  soon  becomes  wrinkled  and  the  face  old-looking. 

When  the  bronchial  glands  are  much  affected  the  attack  is 
marked  by  a  more  irritative  and  spasmodic  cough,  more  catarrh, 
dyspnoea,  and  greater  general  suffering.  Hemorrhage  may 
occur  from  the  suppuration  of  a  bronchial  gland  involving  a 
vessel. 

What  are  the  physical  signs  ? 

Inspection.  Shows  slight  depressions  in  the  supra-clavicular 
and,  in  some  cases,  in  the  infra-clavicular  regions,  but  not  as 
marked  as  in  adults. 

Palpation.  Vocal  fremitus  slightly  increased,  but  is  a  sign 
of  less  value  and  reliability  in  the  child  than  in  the  adult. 
When  present  it  shows  strong  evidence  of  consolidation,  but  it 
may  frequently  be  absent  and  the  latter  exist. 

Percussion.  Very  slight  impairment  of  the  normal  percus- 
sion resonance  is  noticed  at  first ;  as  the  disease  progresses  the 
resonance  is  much  impaired  and  gradually  becomes  dull,  with 
circumscribed  spots  of  the  amphoric  or  cracked-pot  sound. 

Auscultation.     At  the  commencement  of  the  deposition  of 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  181 

the  tubercles  the  breathing  is  weak  or  bronchial,  often  impart- 
ing a  peculiar  click  at  the  close  of  inspiration.  Later,  moist 
rales — sibilant,  mucous,  and  subcrepitant — are  heard  over  one 
or  both  sides  of  the  chest ;  and  later,  after  the  tissue  breaks  up 
and  cavities  form,  bronchial  breathing,  associated  with  large 
and  small  moist  or  bubbling  rales,  will  be  heard.  Rilliet  and 
Barthez  consider  that  harsh  and  prolonged  respiration,  with  in- 
crease in  vocal  resonance,  is  the  most  significant  symptom  of 
crude  tubercle,  particularly  when  heard  over  the  greater  part 
of  the  lung,  or  at  any  rate  not  confined  to  the  apex. 

"What  are  the  complications  ? 

Tubercular  disease  of  the  brain  and  its  membranes  ;  pleura, 
intestines,  and  peritoneum. 

What  is  the  diagnosis? 

The  early  diagnosis  rests  mainly  on  the  history.  The  first 
stages  may  be  taken  for  malnutrition,  aua3mia,  disease  of  the 
heart,  etc. 

What  is  the  prognosis? 

Unfiavorable  ;  complete  recovery  is  very  doubtful. 

What  is  the  treatment? 

The  child  should  be  given  the  most  nutritious  food.  Small 
quantities  of  stimulants  are  of  value.  A  small  amount  of  ale 
or  stout  may  be  given  with  the  mid-day  meal.  Every  possible 
attention  should  be  paid  to  the  child's  health.  It  should  be 
allowed  to  sleep  in  a  large,  well-ventilated  room.  If  tiie  cli- 
mate be  damp  the  patient  should  be  removed  to  some  dry  sea- 
side or  mountain  resort.  Cold,  dry  weather  is  very  beneficial 
in  early  cases,  provided  the  clothes  are  warm.  Of  drugs,  cod- 
liver  oil  is  the  sheet-anchor.  It  may  be  given  in  the  form  of 
a  good  emulsion,  or,  if  this  be  not  at  hand,  in  water,  orange- 
wine,  a  little  whiskey  diluted  with  water,  milk,  or  coffee. 

The  following  is  a  very  good  formula  : — 


182  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

^.     01.  Morrliuse  l^'.v. 
Ex.  Malt  (dry)  §j. 
Calcii  Hypoplios., 
Sodii  Hypophos.  aa  gr.  xxxij. 
Potass.  Hypoplios.  gr.  xvj. 
Grlycerinse  f^oS. 
Pulr.  Acaciae  §ss. 
Aquae  q.  s.  ad  f^viij. — M. 
Sig.  Teaspoonful  three  times  a  day  for  a  child   of  three  years. 

(^Goodhart  and  Starr.) 

Any  digestive  disorders  should  be  treated  at  once  by  appro- 
priate doses  of  pepsin,  bicarbonate  of  sodii,  etc.  If  diarrhoea 
be  present  it  must  be  checked  by  the  use  of  chalk,  or  the 
bismuth  mixture  mentioned  under  the  heading  of  Diarrha3a. 

If  there  are  night  sweats  very  minute  doses  of  atropia  will 
be  of  value  varying  from  25^  to  t4o  ^^  ^  grain  at  bedtime. 
The  chloride  of  calcium  is  useful  and  may  be  given  in  doses  of 
five  to  ten  grains  three  times  a  day,  suspended  in  some  extract 
of  licorice,  glycerine  and  water.  Iodoform  has  been  used  in 
half  and  one  grain  doses  in  powder  form  mixed  with  sugar, 
this  should  be  given  very  cautiously. 

Counter  irritation  should  be  made  by  the  use  of  mustard 
plasters,  but  preferably  stimulating  liniments.  For  the  cough, 
some  simple  expectorant  may  be  used  containing  belladonna. 
Should  haemoptysis  appear,  a  very  uncommon  occurrence  in 
children,  small  doses  of  turpentine  should  be  employed  either 
dropped  on  a  lump  of  sugar  or  suspended  in  syrup. 

Pleurisy. 

What  are  the  synonyms? 
Pleuritis  ;  stitch  in  the  side. 

What  is  the  definition? 

A  fibrinous  inflammation  of  the  pleura,  occurring  either 
idiopathically  or  secondarily. 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  183 

What  are  the  causes  ? 

Idiopathic  pleurisy  is  due  to  cold,  exposure,  and  injuries  to 
the  chest  walls.  Rare  under  five  years  of  age.  Secondary 
pleurisy  may  occur  during  an  attack  of  pneumonia,  rheumatism, 
pericarditis,  and  variola. 

What  is  the  pathological  anatomy  ? 

In  the  early  stage  general  redness  and  vascular  injection  of 
the  pleura  with  bands  of  whitish  and  more  or  less  translucent 
or  opaque  coagulable  lymph,  causing  adhesions  of  the  pulmonary 
and  costal  pleura.  Later,  serous  or  purulent  effusion,  in  vari- 
able quantity  ;  sometimes  displacement  of  the  heart,  lungs,  and 
liver,  and  bulging  of  the  ribs  and  intercostal  spaces. 

What  are  the  symptoms  ? 

The  disease  may  be  ushered  in  with  depression,  loss  of 
appetite,  and  in  older  children,  rigors;  then  an  acute  sharp 
pain ;  the  well-known  pleuritic  stitch  aggravated  by  inspira- 
tion, coughing,  or  lying  on  the  affected  side. 

Sometimes  vomiting,  fever,  and  a  short  dry  hacking  couo-h 
are  the  earliest  symptoms  ;  the  breathing  is  hurried,  the  tongue 
heavily  coated,  the  bowels  constipated,  the  pulse  very  rapid 
and  hard,  the  skin  hot,  the  face  is  flushed,  and  the  urine  scanty 
and  high  colored.  Difficulty  in  breathing  is  more  marked  in 
young  children,  and  when  the  effusion  forms  rapidly,  the  respi- 
rations are  from  thirty-six  to  forty-eight  to  the  minute.  The 
pulse  for  the  first  few  days  varies  from  130  to  140  per  minute, 
and  at  this  period  the  temperature  frequently  runs  up  to  103^ 
or  104°  F.,  but  it  drops  early,  and  the  disease  runs  its  course 
with  a  temperature  of  from  101°  to  102°  F. 

What  are  the  physical  signs  ? 

Inspection.  Deficient  movement  of  the  affected  side  which 
is  due  to  the  pain  caused  by  full  breathing. 

When  effusion  takes  place,  the  degree  of  bulging  of  the 
affected  side  is  by  reason  of  the  comparative  elasticity  of  the 


184  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

chest  walls  greater  in  children  than  in  adults.  The  respiratory 
movements  of  the  affected  side  are  almost  abolished,  and  there 
is  bulging  of  the  intercostal  spaces. 

Palpation.  Diminution  of  vocal  fremitus  over  the  site  of 
the  effusion  and  exaggerated  above  it. 

Percussion.  During  the  first  stage,  slightly  impaired  ;  when 
the  effusion  has  formed,  dull  or  even  flat  over  the  site  of  the 
fluid,  and  tympanitic  above  it. 

Auscultation.  The  friction  sound  is  often  absent  in  young 
children  during  the  early  stages  of  the  disease,  to  appear  dur- 
ing absorption.  Bronchial  breathing  is  usually  heard  at  first 
during  inspiration,  but  afterwards  it  exists  both  during  inspira- 
tion and  expiration  ;  as  the  effusion  subsides  it  is  replaced  by 
feeble  vesicular  breathing,  with  or  without  friction  sounds,  and 
later  by  normal  respiration,  -^gophony  can  rarely  be  detected 
in  children  less  than  two  years  old. 

What  is  the  diagnosis? 

From  pneumonia,  the  sharpness  of  the  pain  in  the  side,  the 
friction  sound,  if  it  be  present,  and  absence  of  crepitant  rales ; 
after  effusion  has  formed,  especially  by  the  change  of  the  lines 
of  dulness  with  change  of  position ;  by  the  bulging,  etc. 

What  is  the  prognosis? 

Fibrinous  or  serous  pleurisy  is  seldom  fatal. 

What  is  the  treatment? 

The  onset  is  best  treated  by  moderate  doses  of  opium  to  re- 
lieve the  pain  and  cough ;  salines,  such  as  the  nitrate  and 
citrate  of  potassium,  or  some  effervescing  saline,  to  act  as  a 
diuretic  and  diaphoretic.  In  the  acute  stage  warm  fomenta- 
tions should  be  used.  In  older  children  the  side  may  be  care- 
fully strapped,  and  warmth  can  be  applied  by  hot  compresses 
outside  the  strapping. 

After  the  third  or  fourth  day  of  the  attack  the  iodide  of 
potassium  should  be  combined  with  the  syrup  of  the  iodide 


DISEASES    OF    THE    ORGANS    OF    RESPIRATION.  185 

of  iron,  keeping  the  bowels  freely  moved  by  some  mild  ape- 
rient. In  some  cases  the  general  symptoms  clear  up  rapidly; 
the  dulness  still  remains,  due  to  the  large  amount  of  lymph. 
Under  these  circumstances  it  is  best  to  apply  counter-irritation 
externally  by  means  of  the  following  liniment : — 

^.     Tr.  Iodine  f^j. 

Potass.  lodid.  fss. 
Camphorae  5ij' 
Spt.  Rect.  Ifx.— M. 
Sig. 

When  the  effusion  takes  place  rapidly,  and  the  quantity  is 
very  large,  with  displacement  of  the  heart,  high  fever,  pallor, 
and  puffiness  of  the  face,  aspiration  should  be  performed. 

If  after  using  the  exploring  needle  the  liquid  is  found  to  be 
pus  (empyema),  it  should  be  at  once  removed  by  one  of  the 
following  methods  :  Aspiration,  tapping  by  trocar  and  canula, 
and  by  making  a  free  incision  and  inserting  drainage-tube; 
this  is  an  operation  which  is  not  attended  by  any  serious  risk, 
and  is  very  successful. 

The  after-treatment  should  consist  of  plenty  of  fresh  air,  a 
wholesome  diet,  and  a  general  tonic  treatment. 


186  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

PART   XII. 
Diseases  of  the  Heart. 

"What  are  the  chief  causes  of  disease  of  the  heart  in  children  ? 

Acute  rheumatism,  chorea,  scarlatina,  diphtheria,  pneumo- 
nia, pleurisy,  typhoid  fever,  syphilis,  and  congenital  malfor- 
mations. 

Pericarditis. 

What  is  the  definition  ? 

An  acute,  fibrinous  inflammation  of  the  pericardium. 

What  are  the  causes  ? 

May  be  the  result  of  taking  cold,  but  usually  secondary  to 

rheumatism,  pneumonia,  pleurisy,  etc. 

What  is  the  pathological  anatomy  ? 

In  the  first  stage  there  is  redness  of  the  membrane,  which 
may  be  diffused,  punctated,  or  in  patches.  Then  deposits  of 
lymph  form,  and  sometimes  cause  local  or  general  adhesion  of 
the  two  layers  of  serous  membrane,  followed  by  the  effusion 
of  a  sero-fibrinous  fluid,  becoming  purulent  more  often  in  chil- 
dren than  in  adults. 

What  are  the  symptoms? 

In  some  cases  the  symptoms  are  obscure,  pericarditis  occur- 
ring with  but  little  pain  or  uneasiness  ;  on  the  other  hand,  in 
others  the  disease  is  manifested  by  intense  pain  in  the  cardiac 
region,  shooting  to  the  shoulders  and  then  down  the  arms,  and 
much  fever.  The  heart  beats  irregularly  and  with  a  labored 
impulse ;  the  breathing  is  rapid,  the  face  anxious,  the  head 
aches,  the  temples  throb,  and  there  may  be  paroxysms  of  im- 
pending suffocation,  bleeding  at  the  nose,  or  haemoptysis. 


DISEASES    OF    THE    HEART.  187 

What  are  the  physical  signs  ? 

Inspection.     First  stage,  cardiac  action  excited. 

When  effusion  has  appeared  the  impulse  is  feeble  or  absent ; 
there  may  be  bulging  of  the  praecordium. 

Palpation.  First  stage,  excited  ;  thumping  impulse,  which 
may  be  feeble  or  even  absent  when  effusion  appears. 

Percussion.  First  stage,  normal.  After  the  -effusion  has 
formed  there  is  an  increased  area  of  cardiac  dulness  propor- 
tionate to  the  quantity  of  fluid  present. 

Auscultation.  First  stage,  excited  cardiac  action,  with  a 
friction  sound.  When  the  effusion  forms  these  sounds  are 
very  feeble  and  deep-seated,  being  most  distinct  at  the  cardiac 
base.  If  the  fluid  is  absorbed  the  friction  sound  returns  and 
then  gradually  disappears. 

What  is  the  diagnosis  ? 

From  endocarditis,  the  absence  of  dulness  on  percussion,  the 

endocardial  sounds  are  less  distinct,  and  valvular  murmurs  fol- 
low endo-  and  not  pericarditis. 

What  is  the  prognosis  ? 

More  fatal  in  children  than  in  adults. 

What  is  the  treatment  ? 

The  child  should  be  kept  in  bed,  perfectly  quiet,  all  exer- 
tion and  excitement  being  guarded  against.  The  diet  must 
consist  of  milk  principally  for  the  first  few  days.  Of  the  local 
treatment  during  the  acute  stage  soothing  applications  are 
more  desirable  than  counter-irritants.  The  extract  of  bella- 
donna may  be  moistened  with  glycerine  and  spread  on  lint  and 
applied  over  the  praecordial  region,  covered  with  cotton  and 
oiled  silk.  If  much  pain  is  complained  of,  a  liglit  mustard 
poultice  (one  part  of  mustard  to  four  parts  of  flour)  may  be 
applied  over  the  heart  and  allowed  to  remain  until  the  skin 
becomes  red.  In  some  cases  leeches  over  the  sternum  will  be 
found  useful.     Of  drugs,  the  salicylate  of  sodium,  with  the  so- 


18i8  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

lution  of  the  acetate  of  ammonia,  should  be  given  if  the  inflam- 
matory lesion  is  dependent  on  rheumatism.  The  iodide  of 
potassium  will  be  found  of  use  in  hastening  absorption.  Tinc- 
ture of  digitalis  may  be  given  in  three  to  five  drop  doses  every 
four  hours  if  there  be  much  dyspnoea  or  sign  of  cardiac  failure. 
For  relieving  the  pain  and  quieting  the  heart's  action  one-half 
to  two  grains  of  Dover's  powder  may  be  given  at  night,  and 
repeated  if  necessary. 

Whenever  the  effusion  accumulates  so  rapidly  or  in  such 
quantity  that  it  threatens  life,  aspiration  or  paracentesis  must 
at  once  be  performed.  During  convalescence  the  child  should 
be  given  plenty  of  fresh  air,  good  food,  and  kept  on  a  tonic 
treatment  of  quinine,  iron,  and  strychnine. 

Endocarditis. 

What  is  the  definition? 

An  inflammation  of  the  lining  membrane  of  the  heart. 

What  are  the  causes  ? 

Acute  articular  rheumatism,  pneumonia,  pleurisy,  pericar- 
ditis, scarlatina,  etc. 

What  is  the  pathological  anatomy  ? 

In  the  first  stage  the  endocardial  surface  is  briojht  red.  In 
the  second  stage  the  valves  are  involved ;  serum  exudes.  In 
the  third  stage  the  redness  is  lessened,  the  valves  are  thickened. 
In  the  fourth  stage  the  valves  are  shrunken  and  rigid. 

What  are  the  symptoms  ? 

If  the  case  be  severe  there  is  a  violent  disturbance  of  the  cir- 
culation, much  dyspnoea,  and  a  dry,  hacking  cough,  without 
any  physical  signs  of  pulmonary  disease.  The  child  is  very 
restless  and  feverish,  and  when  the  heart  is  auscultated,  an 
abnormal  bruit  is  heard  attending  the  heart's  action ;  the 
valvular  murmur  is  not  harsh,  as  in  some  forms  of  valvular 


DISEASES    OF    THE    HEART.  189 

disease,  but  is  very  gentle  and  soft,  being  heard  with  difficulty. 
The  murmur  is  usually  systolic  in  time,  attending  and  more 
or  less  obscuring  the  first  sound.  In  the  vast  majority  of  cases 
the  mitral  is  the  affected  orifice,  although  the  aortic  valves 
may  be  the  seat  of  disease. 

What  is  the  prognosis  ?    • 
Unfavorable. 

What  is  the  treatment? 
Same  as  for  pericarditis. 

Valvular  Diseases  of  the  Heart. 

What  is  the  definition? 

Alterations  in  the  orifices  or  valves  of  the  heart. 

What  are  the  causes  ? 

In  children  usually  the  result  of  endocarditis,  most  frequently 
affecting  the  mitral  valves. 


Mitral  Regurgitation. 

This  is  the  most  frequent  form  of  cardiac  disease  in  chil- 
dren. It  depends  upon  inflammatory  alterations  in  the  mitral 
valve,  usually  as  a  result  of  endocarditis,  rendering  it  insuf- 
ficient to  close  that  orifice  during  the  systole  of  the  left 
ventricle. 

What  are  the  symptoms  ? 

Shortness  of  breath  on  exertion,  liability  to  cough,  palpita- 
tion of  the  heart,  and  irregular  pulse. 

What  are  the  physical  signs  ? 

Inspection.  Cardiac  impulse  lower  than  normal,  owing  to 
the  enlargement  of  the  heart. 

Palpation.     At  first,  impulse  forcible ;  later,  feeble. 


190  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Percussion.     Cardiac  dulness  increased. 

Auscultation,  A  blowing  murmur  is  heard  with  the  first 
sound  of  the  heart ;  the  second  sound  is  accentuated.  This 
murmur  is  heard  at  the  base,  and  is  transmitted  to  the  apex 
where  it  is  loudest.  It  is  also  transmitted  to  the  axilla  and 
to  the  back  at  the  angle  of  the  scapula. 

What  is  the  prognosis  ? 

Much  more  favorable  in  children  than  in  adults. 

Mitral  Obstruction. 

This  disease  is  not  so  common  as  mitral  regurgitation.  It 
is  seldom  noticed  before  the  age  of  seven  years. 

What  are  the  symptoms? 

Attention  is  usually  attracted  to  the  heart  by  the  increased 
tendency  to  dyspnoea  and  palpitation  on  exertion,  and  by  the 
readiness  with  which  a  bronchial  cough  is  contracted  on  very 
slight  exertion. 

What  are  the  physical  signs  ? 

Inspection.     Prominence  of  the  praecordia. 

Palpation.  Frequently  a  thrill  can  be  felt  over  the  prae- 
cordia. 

Auscultation.  A  low,  hoarse,  presystolic  murmur  is  heard. 
This  murmur  follows  the  second  sound  and  stops  just  before, 
or  else  runs  into,  the  time  of  the  first  sound.  The  seat  of  greatest 
intensity  is  at  the  apex.     It  is  not  transmitted  in  any  direction. 

What  is  the  prognosis? 

As  regards  prolongation  of  life,  favorable. 

What  is  the  general  treatment? 

The  patient  must  be  kept  perfectly  quiet ;  he  should  be 
warmly  clothed  and  carefully  protected  from  any  exposure. 
All  violent  exertion  of  the  body  and  mind  must  be  avoided. 


DISEASES    OF    THE    HEART.  101 

The  diet  should  be  of  the  most  nutritious  kind.  The  drugs  of 
most  service  to  control  and  regulate  the  cardiac  contractions 
are  digitalis,  belladonna,  iron,  strychnine.  Digitalis  is  of 
much  value,  but  care  must  be  taken  not  to  give  it  too  lono- ; 
an  intermittency  in  the  pulse  beat  should  at  once  point  to  hs 
omission.  When  dropsy  sets  in,  digitalis,  with  iodide  of  potas- 
sium, acetate  of  potash,  and  squills  may  be  used. 

Diseases  of  the  Aortic  Valves. 

These  affections  are  very  rare  in  children.  If  the  lesion 
causes  obstruction  of  the  aortic  orifice,  the  murmur  will  be 
heard  with  the  first  sound  of  the  heart;  if  there  be  regurgita- 
tion through  the  valve  it  will  be  heard  with  or  take  the  place 
of  the  second  sound.  The  lesion  may  cause  obstruction  and 
insufficiency  when  a  double  murmur  is  heard. 

What  is  the  character  of  the  pulse? 

lieceding,  known  as  the  "  water-hammer"  pulse  in  aortic 
regurgitation. 

What  are  the  physical  signs  of  aortic  regurgitaticn  ? 
Inspection.     Cardiac  impulse  strono-. 
Palpation.     Impulse  strong. 

Percussion,  Cardiac  dulness  increased,  transversely  and 
vertically. 

Auscultation.  Blowing  murmur  is  heard  at  the  second  right 
costal  cartilage,  but  is  probably  more  distinct  at  the  junction 
of  the  sternum  and  the  fourth  left"  costal  cartilage. 

What  is  the  prognosis? 

More  favorable  in  children  than  adults. 


192  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

Congenital  Heart  Disease. 

Malformations  of  the  heart  are  very  numerous,  and  although 
of  interest  to  tlie  anatomist,  are  of  little  practical  importance 
to  the  physician. 

What  are  the  principal  causes? 

Persistence  of  foetal  openings,  more  particularly  the  foramen 
ovale,  in  consequence  of  the  lungs  remaining  in  part  in  the 
foetal  state  after  birth  ;  there  is  obstruction  through  the  lungs 
and  overfilling  of  the  right  heart. 

Endocarditis,  occurring  during  foetal  life,  affecting  the  pul- 
monary, the  tricuspid,  and  less  often  the  aortic  or  mitral  valves, 
producing  stenosis  at  the  valvular  orifice.  An  arrest  of  develop- 
ment at  some  period  of  foetal  life  or  the  results  of  a  false  step, 
as  it  were,  as  when  a  transposition  of  the  aorta  and  pulmonary 
artery  occurs. 

What  axe  the  symptoms  ? 

Cyanosis  and  the  presence  of  a  bruit  are  reliable  signs  of 
congenital  heart  disease.  Cyanosis  in  some  cases  is  only 
present  when  the  infant  cries.  Cyanosis  is  also  present  in 
prematurely  born  infants ;  if,  however,  the  cyanosis  persists 
for  many  weeks  it  is  probably  due  to  malformation  of  the 
heart.  In  a  certain  number  of  cases  murmurs  of  a  rough, 
rasping  character  are  heard. 

What  is  the  prognosis? 
Very  grave. 

What  is  the  treatment  ? 

Infants  must  be  well  clothed  and  kept  as  much  as  possible 
in  a  uniform  temperature.  A  case  of  bronchial  catarrh  in  one 
of  these  cases  would  most  likely  prove  fatal.  The  diet  should 
be  carefully  regulated  and  given  in  small  quantities  at  frequent 
intervals.  If  emaciation  appears,  tonics,  cod-liver  oil,  and  malt 
must  be  given. 


DISEASES,  OF    THE    GENITO-URINARY    ORGANS.  193 


PART   XIII. 

Diseases  of  the  Genito-Urinary  Organs. 

Haematuria. 

What  is  the  definition? 

An  admixture  of  blood  with  the  urine. 

What  are  the  causes  ? 

Scrofulous  disease  of  the  kidney  or  bladder ;  renal  or  vesical 
calculus;  small  growths  about  the  urethra;  nephritis;  renal 
tumor  or  cystitis. 

What  are  the  symptoms? 

In  some  cases  a  small  quantity  of  blood  will  appear  in  the 
urine  once  or  twice  a  day,  and  frequently  disappears  and  does 
not  return.  In  other  cases  blood  is  passed  in  large  quantities, 
the  urine  having  the  appearance  of  port-wine. 

What  is  the  treatment? 

The  child  must  be  kept  in  bed  for  a  few  days  and  given  a 
liquid  diet.  For  the  bleeding,  gallic  acid,  tincture  of  the  chlo- 
ride of  iron,  alum,  or  the  acetate  of  lead  may  be  used.  Bleed- 
ing from  the  bladder  may  be  treated  by  the  injection  through  a 
catheter  of  a  weak  solution  of  alum,  sulphate  of  zinc,  or  tannic 
acid.  The  bowels  should  be  kept  freely  opened  and  the  general 
health  looked  after. 

Anuria. 

What  is  the  definition  ? 

'    A  temporary  suppression  of  the  urine. 

What  are  the  causes  ? 

An  excess  of  uric  acid  in  the  urine. 
13 


194  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  are  the  symptoms? 

It  rarely  lasts  more  than  a  few  hours,  and  the  symptoms  are 
pain  and  much  discomfort  when  micturition  takes  place.  The 
urine  upon  examination  will  be  found  to  be  highly  acid,  and, 
microscopically,  crystals  of  uric  acid  will  be  revealed  in  enor- 
mous quantities. 

What  is  the  treatment  ? 

The  child  should  be  kept  in  bed  and  hot  fomentations  placed 

over  the  lower  part  of  the  abdomen.  If  relief  is  not  obtained 
by  this  method,  drop  doses  of  the  tincture  of  belladonna  may  be 
employed,  repeated  every  fifteen  or  twenty  minutes,  care  being 
taken  to  watch  the  pupils  and  face  for  the  physiological  effects. 


Pyuria. 


What  is  the  definition  ? 

Pus  in  the  urine. 


What  are  the  causes  ? 

Cystitis  ;  scrofulous  disease  of  the  kidney  ;  stone  in  the  kid- 
ney or  bladder,  and  from  any  vaginal  or  pudendal  discharge. 

What  are  the  symptoms  ? 

Frequent  and  straining  micturition,  causing,  in  some  cases, 
intense  pain.  The  urine  may  be  faintly  alkaline,  containing 
albumen  and  a  large  quantity  of  pus. 

What  is  the  treatment? 

The  child  must  be  kept  perfectly  quiet,  and  given  a  milk 
diet.  The  salicylate  of  sodium,  the  benzoate  of  ammonium, 
and  pareira  brava,  may  be  given  internally. 

Scrofulous  Kidney. 

What  are  the  symptoms? 

Pain  in  the  loin  ;  frequency  of  micturition,  and  a  purulent 
sediment  of  pus  in  the  urine,  occasionally  streaked  with  blood, 


DISEASES    OF    THE    GENITO-URINARY    ORGANS.  195 

but  it  may  be  present  also  without  any  characteristic  symptoms. 
The  disease  usually  commences  in  the  renal  pyramids,  produc- 
ing gradual  erosion  and  excavation  of  the  kidney  ;  it  may  also 
extend  along  the  ureter  to  the  bladder.  One  kidney  is  usually 
much  more  affected  than  the  other,  save  in  very  old  cases, 
when  both  maybe  diseased  and  much  enlarged.  Patients  with 
this  disease  are  susceptible  to  an  attack  of  general  tuberculosis. 

What  is  the  treatment  ? 

The  child's  health  should  be  improved  as  much  as  possible 
in  the  early  stage.  A  trip  to  the  mountains  or  sea-shore  will 
be  of  benefit.  The  food  should  be  most  nutritious,  with  a 
moderate  amount  of  cream  daily.  The  drugs  to  be  employed 
in  the  early  stage  are  cod-liver  oil,  chloride  of  calcium,  and 
iodoform.  In  the  later  stages  of  the  disease,  when  there  is  a 
constant  discharge  of  pus  which  is  uncontrollable,  pain,  fre- 
quent micturition,  and  ansemia,  an  exploratory  operation 
should  be  performed  and  the  kidney  drained,  or,  should  it  be 
necessary,  removed. 

Renal  Calculus. 

What  are  the  synonyms  ? 
Renal  colic ;  gravel. 

What  is  the  definition  ? 

A  body  formed  around  a  substance  from  certain  salts  of  the 
urine. 

What  are  the  causes  ? 

Common  in  children  before  the  fifth  year.  Seems  to  exist 
in  certain  families.     Etiology  not  known. 

What  are  the  symptoms  ? 

In  children  the  [)ain  is  described  as  an  abdominal  pain,  and 
is  pointed  out  by  a  child  to  be  in  the  region  of  the  umbilicus 


196  ESSENTIALS    OP    DISEASES    OF    CHILDREN.  • 

or  front  of  the  abdomen.  A  simple  pyuria,  with  irritability  of 
the  bladder,  may  be  all  that  points  to  the  existence  of  stone. 

Concretions  in  the  kidneys  may  occur  in  two  forms,  namely, 
uric  acid  infarctions,  and  calculi,  varying  in  size  from  that  of  a 
small  shot  to  that  of  a  large  pea. 

Uric  acid  infarctions  are  frequently  found  in  the  kidneys  of 
infants  who  die  soon  after  birth,  and  whose  respiratory  func- 
tions have  been  imperfect  during  life. 

When  the  urinary  excretion  is  increased  the  infarctions  are 
often  washed  into  minute  red  specks,  and  are  found  upon  the 
diaper. 

Should  the  concretions  be  passed  into  the  bladder  and 
retained  there,  they  increase  in  size.  When  retained  in  the 
pelvis  of  the  kidney  they  may  cause  suppurative  pyelitis. 

What  is  the  treatment  ? 

The  child  should  be  given  a  non-albuminous  diet,  warm 
baths,  Buffalo  lithia  or  other  alkaline  waters.  Intense  pain 
must  be  relieved  by  opium. 

Acute  Bright's  Disease. 

What  are  the  synonyms  ? 

Acute  desquamative  nephritis  ;  acute  parenchymatous  neph- 
ritis. 

What  is  the  definition  ? 

An  acute  inflammation  of  the  epithelium  of  the  uriniferous 

tubules. 

What  are  the  causes  ? 

Cold  and  exposure;  the  eruptive  fevers,  especially  scarlatina. 

What  is  the  pathological  anatomy? 

The  kidney  is  enlarged,  its  capsule  is  easily  stripped  off,  and 
the  color  in  the  earlier  stage  is  deep  red ;  as  the  disease  pro- 
gresses it  is  mottled  red  and  white. 


DISEASES    OF    THE    GENITO-URINARY    ORGANS.  197 

What  are  the  symptoms  ? 

The  disease  is  ushered  in  suddenly  ;  chilliness,  followed  by 
fever,  restlessness,  pains  across  the  lumbar  region  and  the 
loins,  nausea  and  vomiting.  Dropsy  is  an  early  symptom  and 
the  face  is  the  first  part  to  be  affected  ;  a  puffiness  is  noticed 
under  the  eyes,  then  the  body  generally  becomes  swollen,  and 
there  may  be  occasionally  effusion  in  the  pleura ;  the  urine  be- 
comes scanty,  it  is  dark  in  color,  and  loaded  with  albumen. 
Microscopically,  it  is  found  to  be  filled  with  crystals  of  lithate 
of  ammonia,  mucus,  casts  of  the  tubules,  and  blood  corpuscles. 

What  is  the  diagnosis  ? 

The  history,  fever,  dropsy  always  beginning  in  the  face  ;  the 
scanty,  dark-colored  urine,  filled  with  albumen,  makes  the  diag- 
nosis easy. 

What  is  the  prognosis? 

Favorable  ;  rarely  passes  into  the  chronic  form. 

What  is  the  treatment? 

The  child  must  at  once  be  put  to  bed.  The  diet  should  con- 
sist of  milk  and  animal  broths.  The  bowels  should  be  opened 
once  daily  v^ith  a  seidlitz  powder.  A  bath  of  100*-*  F.  should 
be  given  night  and  morning.  Digitalis  must  be  given  inter- 
nally. The  following  mixture  is  recommended  by  Goodhart 
and  Starr  :— 

5.     Tr.  Digitalis  f5ss. 

Liq.  Ammon.  Acetat.  f  ^iss. 
Spt.  ^ther.  Nitro.  f  5ij. 
Sjr.  Tola  f^ss. 
Aquae  Carl  q.  s.  ad  f  ^iij. — M. 
Sig.  Teaspoonful  every  two  hours  for  a  child  of  six  or  eight  years. 

Or, 

J^.     Potass.  Acetat.  5iss. 
Tr.  Digitalis  f5j. 
Elix.  Simp,  ^'j- 
Aquje  q.  s.  ad  f fiij. — M. 
Sig.  Tcaspoouful  every  two  or  three  hours. 


198  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

If  there  be  a  tendency  to  suppression  of  the  urine,  or  should 
convulsions  be  threatened,  free  purgation  must  be  induced  and 
the  bromide  of  potassium  given.  After  the  acute  symptoms 
have  subsided,  the  dropsy  diminished,  and  the  flow  of  urine 
has  increased,  iron  should  be  administered  in  the  lorm  of 
"  Basham's  mixture." 


Nocturnal  Incontinence  of  Urine. 

What  is  the  synonym  ? 

Enuresis. 

What  is  the  definition  ? 

An  involuntary  expulsion  of  urine  occurring  during  sleep. 

What  are  the  causes  ? 

Occasionally  associated  with  renal  disease,  also  worms,  rheu- 
matism, constipation,  and  adherent  prepuce.  It  may  also  be 
caused  by  an  excessive  use  of  liquids  or  by  lying  on  the  back 
during  sleep. 

What  is  the  treatment  ? 

Much  stress  should  be  laid  upon  diet  and  general  regimen. 
The  quantity  of  drink  should  be  restricted,  and  no  fluid  should 
be  allow^ed  after  four  or  five  o'clock  in  the  afternoon  for  some 
'time  after  the  child  is  considered  cured.  The  child  should  be 
taken  up  to  urinate  late  at  night,  early  in  the  morning,  and,  if 
necessary,  once  during  the  night,  and  should  always  be  thor- 
oughly awakened. 

Very  little  meat  should  be  allowed  if  the  patient  shows  any 
rheumatic  symptoms  ;  indeed,  I  think  children  do  better  with- 
out it,  owing  to  the  effect  it  has  of  acidifying  the  urine,  which 
irritates  the  bladder  and  provokes  expulsion. 

The  child  should  be  kept  in  the  fresh  air  as  much  as  pos- 
sible, provided  the  weather  be  fine,  and  allowed  to  exercise, 
care  beinsr  taken  to  have  flannel  next  to  the  skin  and  the  feet 


DISEASES    OF    THE    GENITO-URINARY    ORGANS.  I99 

well  protected  with  stout  shoes.  The  child  should  be  given  a 
cool  or  even  cold  sponge  bath  each  morning,  with  a  tablespoon- 
ful  of  sea-salt  added.  The  body  should  then  be  briskly  rubbed 
with  a  moderately  coarse  bath  towel,  especially  in  the  region 
of  the  spine. 

Should  phimosis  be  present,  circumcision  will  usually  relieve 
the  trouble.  If  the  prepuce  be  adherent,  the  adhesions  should 
be  broken  up  and  the  part  kept  well  greased. 

The  following  drugs  are  prescribed  :  Belladonna  in  the  form 
of  the  tincture,  commencing  with  minute  doses  and  gradually 
increasing  until  the  physiological  effects  are  noticed.  Bromide 
of  potassium  and  chloral  seem  to  be  of  service  in  some  cases. 
One  of  the  later  drugs  which  has  met  with  flattering  success  is 
the  fluid  extract  of  rhus  aromatica.  In  carrying  out  the  treat- 
ment with  this  drug  it  is  well  to  commence  with  minute  doses, 
gradually  increasing  a  drop  or  two  each  day  so  as  to  prevent 
any  gastric  disturbance.  It  is  best  given  in  a  little  sweetened 
water  or  the  aromatic  elixir.  The  following  is  a  very  palatable 
formula  for  young  children  : 

ij:.     Ex.  Rhois  Aromat.  Fl.  f  5iij. 
Elix.  Aromat.  f^iss. 
Aquae  Cinnam.  q.  s.  ad  f^iij. — M. 
Sig.  Half  teaspoonful,  to  be  increased  to  one  teaspoonful  four  times 
a  day  after  eating. 

For  a  child  of  three  or  five  years  the  dose  should  be  five 
drops,  increased  daily. 


200  ESSENTIALS    OF    DISEASES    OF    CIIILDUEN. 

PART    XIV. 

Diseases  of  the  Skin. 

Miliaria. 

What  are  the  synonyms  ? 

Lichen  ;  miliaria  alba  ;  miliaria  rubra  ;  prickly  heat. 

What  is  the  definition  ? 

An  acute  inflammation  of  the  sweat  glands,  characterized  by 
the  sudden  appearance  of  sharply  raised,  whitish  or  reddish 
rounded  papules,  covering  the  cheeks,  arms,  legs,  back,  abdo- 
men, often  with  a  translucent  centre. 

What  is  the  cause? 

Excessive  heat,  most  common  during  dentition. 

What  are  the  symptoms  ? 

The  eruption  appears  suddenly  in  the  form  of  bright-red 
papules  about  the  size  of  a  pin's  head.  The  child  is  restless 
and  fretful  and  often  refuses  to  nurse,  and  if  he  does  only  a 
part  of  the  bottle  will  be  taken. 

What  is  the  duration  ? 

It  may  last  from  a  few  hours  to  weeks. 

What  is  the  treatment? 

The  child  should  be  kept  as  cool  as  possible  and  the  body 
sponged  night  and  morning  with  warm  water  in  which  has 
been  added  a  drachm  of  the  bicarbonate  of  sodium.  The 
clothing  should  be  as  light  as  possible.  The  solution  of  the 
citrate  of  potassium  may  be  given  to  a  child  one  year  old  in 
drachm  doses  every  two  hours,  or  one  of  the  following : — 


DISEASES    OF    THE    SKIN.  201 

^.     Spt.  iEth.  Nit.  f  5j. 
Magnesii  Sulphat.   5J* 
Olei  Cajuput  n\^j. 
Syr.  Tolu  f5ij. 
Liq.  Magnesii  Carb.  f  ^ij. — M. 
Sig.  Teaspoonful  two  or  three  times  a  day.        {Goodhart  and  Starr. ^ 

B.     Sodii  Bicarb.  5J' 

Tr.  Nucis  Vomicse  lilvj. 
Tr.  Cardamom.  Comp.  fS'j' 
Syrupi  f5ij. 
Aquae  Chloroform  f  ^ss. 
Aquae  q.  s.  ad  f§ij. — M. 
Sig.  Teaspoonful  every  six  hours.  {Eustace  Smith.) 

Externally,  equal  parts  of  Goulard's  cerate  and  vaseline  will 
be  found  of  service  applied  night  and  morning,  or  the  following 
dusting  powder : — 

^.     Hydrarg.  Chlor.  Mit.  gr.  xx. 
Lycopodii  5ij' — M. 
Sig.  Dust  parts  as  required. 

Powdered  oxide  of  zinc  and  starch  are  also  useful. 


Acute  Urticaria. 

What  are  the  synonyms  ? 
Nettlerash  ;  hives. 

What  is  the  definition  ? 

An  inflammatory  disease  of  the  skin,  characterized  by  the 
development  of  wheals  of  a  whitish  or  reddish  color,  accom- 
panied by  pricking  tingling  sensation. 

What  are  the  causes  ? 

Errors  in  diet ;  the  sting  of  an  insect ;  idiosyncrasy. 

What  are  the  symptoms  ? 

When  the  wheal  appears  intense  itching,  burning,  tingling 


202  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

pricking  are  present,  and  the  child  to  relieve  the  irritation  vio- 
lently scratches  the  skin. 

What  is  the  treatment  ? 

The  diet  should  be  carefully  looked  into,  and,  if  found  to  be 
improper,  rectified.  To  relieve  the  itching,  equal  parts  of 
glycerine  and  the  bicarbonate  of  sodium  may  be  rubbed  gently 
into  the  parts ;  sponging  with  vinegar  and  water  will  also  be 
found  useful.  The  following  lotion  is  recommended  by 
Duhring  : — 

I^.     Acid.  Carbol.  f5j. 
Glycerinse  fSiJ- 
Alcoholis  f^v'iij. 

Aquae  Amygdal.  Amar.  f  §viij. — M. 
Sig.  Bathe  parts  twice  daily. 

Eczema. 

What  are  the  synonyms? 
Tetter ;  salt  rheum. 

What  is  the  definition? 

A  non-contagious  inflammation  of  the  skin,  characterized  by 

erythema,  papules,  vesicles,  or  pustules. 

What  are  the  causes? 

Improper  food,  dentition,  worms,  gastro-intestinal  disorders. 

What  are  the  symptoms  ? 

Heat,  swelling,  and  redness  of  the  part  affected,  with  itching 
and  at  times  burning.  The  commonest  places  for  ecaema  in 
infants  and  young  children  are  the  forehead,  cheeks,  scalp, 
backs  of  the  ears,  flexures  of  the  joints,  and  backs  of  the 
hands.  In  weakly  and  scrofulous  children  less  redness,  burn- 
ing, and  itching  are  found,  and  a  greater  tendency  to  pus 
formation  than  when  the  disease  occurs  in  strong  and  healthy 
children.     The  disease  is  apt  to  relapse. 


DISEASES    OF    THE    SKIN.  203 

What  is  the  diagnosis  ? 

Inflammation,  swelling,  oedema,  thickening,  redness,  itching 
and  burning,  the  discharge  or  moisture  followed  by  crusting; 
after  removing  the  crust  a  moist  surface  is  shown. 

What  is  the  treatment  ? 

The  child's  diet  should  be  carefully  regulated  and  all  starchy 
and  saccharine  foods  avoided.  If  the  bowels  be  constipated 
an  aperient  water  may  be  given  daily  before  breakfast,  or, 
what  is  better  still,  a  small  dose  of  calomel.  A  powder  con- 
taining five  grains  each  of  the  bicarbonate  of  sodium  and 
sulphur  may  be  given  three  or  four  times  a  day.  If  the  child 
be  scrofulous  the  syrup  of  the  iodide  of  iron  and  cod-liver  oil 
must  be  used.  When  there  is  much  itching  a  dose  of  chloral 
may  be  given  at  bedtime  and  occasionally  repeated  during  the 
day,  and  Dr.  Eustace  Smith  recommends  from  one-half  to  one 
grain  one  hour  before  bedtime  in  such  cases.  Locally,  any 
of  the  following  applications  will  be  found  useful : — 

Iji.     Acid.  Carbol.  TlT^xij. 

Hydrarg.  Chlor.  Mit.  gr.  xvj. 
Ungt.  Zinci  Ox., 
Vaseline  aa  §ss. — M. 
Sig.  Use  locally. 

I^.     Vini  Opii  f5j. 

Liq.  Plumbi  Subacetat.  TT|^xxxvj. 
Aquae  Rosae  q.  s.  ad  f  §viij. — M. 
Sig.  Use  locally. 

B.     Liq.  Potass.  Arsenitis  t1\,xij. 
Vini  Ferri  Amar., 
Syr.  Tolu  aa  f^ss. 
Aquae  Cinnam.  q.  s.  ad  f  ^ij. — M. 
Sig.  Teaspoonful  three  times  a  day  for  au  anaemic  child  of  two  years. 

Soap  should  be  avoided  as  much  as  possible  in  eczema,  but 
the  parts  must  be   kept   perfectly  clean  by  the  use  of  warm 


204  ESSENTIALS    OB'    DISEASES    OF    CIIILDREN. 

water   and  carefully  dried   with  a  soft  towel,  especially  the 
folds  about  the  neck,  buttocks,  etc. 

Impetigo. 

What  is  the  definition  ? 

An  acute,  inflammatory  disease,  characterized  by  discrete, 
rounded,  and  elevated  pustules,  unattended  by  itching. 

What  are  the  causes  ? 

Usually  occurs  in  well-nourished  and  healthy  children  be- 
tween the  ages  of  three  and  ten  years. 

What  are  the  symptoms  ? 

The  eruption  may  be  attended  with  slight  constitutional 
symptoms,  as  restlessness,  loss  of  appetite,  constipation,  etc. 
The  pustules  come  out  one  or  more  at  a  time,  being  scattered 
and  never  tending  to  coalesce.  They  are  most  common  on  the 
face  and  scalp,  but  may  appear  on  any  part  of  the  body. 

What  is  the  treatment? 

The  pustules  should  be  opened  as  they  mature  and  protected 
from  rubbing  and  violence  by  the  ammoniated  mercurial  oint- 
ment or  an  ointment  containing  bismuth  and  cold  cream. 

Ecthyma. 

What  is  the  definition  ? 

A  disease  of  the  skin  characterized  by  large,  flat  pustules, 
situated  upon  an  inflammatory  base. 

What  are  the  causes? 

Improper  and  insufficient  diet ;  most  common  among  chil- 
dren of  the  poorer  class  who  are  housed  in  overcrowded  dwell- 
ings. 

What  are  the  symptoms  ? 

The  disease  is  characterized   by  the  appearance  of  one  or 


DISEASES    OF    THE    SKIN.  205 

more  flat,  oval,  or  round  pustules,  about  the  size  of  a  large 
pea,  attended  with  heat,  burning,  and  pain.  The  pustules  are 
at  first  yellow  in  color,  surrounded  by  a  bright-red  areola, 
which  is  quite  sensitive  to  the  touch.  The  duration  of  each 
pustule  varies  from  two  to  three  weeks.  It  usually  appears  on 
the  thighs,  legs,  shoulders,  and  back. 

What  is  the  diagnosis  ? 

Ecthyma  and  pustular  eczema  resemble  each  other,  but  tlie 
clinical  history  should  prevent  error. 

What  is  the  prognosis  ? 

Recovery  is  generally  prompt. 

What  is  the  treatment  ? 

The  child  should  be  kept  perfectly  clean  by  giving  a  tepid 
bath  night  and  morning.  The  diet  should  be  of  the  most  nu- 
tritious kind.  Open-air  exercise,  short  of  fatigue,  should  be 
encouraged. 

Locally,  the  crusts  should  be  softened  with  olive  oil  and  the 
following  ointment  used  : — 

^.     Ungt.  Hydrarg.  Ammoniat.  gr.  xx. 
Ungt.  Zinci  Ox., 
Vaseline  aa  §ss. — M. 
Sig.  Use  locally. 

Furunculus. 

What  are  the  synonyms  ? 

Furunculosis  ;  boil. 

What  is  the  definition  ? 

An  acute  affection  of  the  skin,  characterized  by  the  appear- 
ance of  boils  or  small  abscesses. 

What  are  the  causes  ? 

The  affection  occurs  chiefly  in  young  cliildren,and  especially 


206  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

in  boys  of  eight  or  ten  years  ;  it  usually  results  from  a  depraved 
condition  of  the  system,  local  friction,  or  pressure. 

What  are  the  symptoms  ? 

Boils  may  appear  singly  or  in  crops  ;  they  reach  their  full 
development  in  about  one  week,  they  then  consist  of  a  raised, 
round,  and  pointed  swelling,  with  a  yellowish  cover,  varying 
in  size  from  a  pea  to  a  small  walnut.  The  constitutional 
symptoms  vary  with  the  number  of  lesions.  They  appear 
principally  upon  the  nepk,  face,  back,  and  buttocks. 

What  is  the  prognosis? 

If  many  appear,  they  Impair  the  general  health. 

What  is  the  treatment  ? 

Locally  the  inflammation  must  be  protected  from  all  irrita- 
tion. In  the  early  stages  the  removal  of  the  small  head  and 
the  insertion  of  a  drop  of  glycerinum  acidi  carbolici  may  ease 
the  pain  and  arrest  the  extension  of  the  slough.  Internally, 
Easton's  syrup,  maltine^  or  good  stout  may  be  given.  Sulphide 
of  calcium  can  be  used  with  good  effect.  The  diet  should  be 
carefully  regulated,  and  all  hygienic  faults  corrected. 

Bromide  Eruption. 

What  is  the  definition  ? 

A  maculo-papular,  or  pustular  eruption,  caused  by  the  use 
of  the  salts  of  bromine. 

What  is  the  cause  ? 

The  use  of  the  salts  of  bromine. 

What  are  the  symptoms  ? 

There  are  no  constitutional  symptoms.  Large,  dryish,  red, 
w^arty  granulations  rise  sharply  from  the  skin,  which  is  appar- 
ently healthy,  with  scarcely  a  trace  of  inflammation  surrounding 
them.     The  masses  are  sore  to  the  appearance,  yet  discharge 


DISEASES    OF    THE    SKIN.  207 

but    little,  and    are   more  like    condylomata    than    any    other 
affection. 

What  is  the  treatment  ? 

The    drug    should    be    discontinued  at  once ;    the  eruption 
treated  as  any  local  ulcer. 


Herpes. 

What  is  the  definition  ? 

An  acute  inflammation  of  the  skin,  characterized  by  the 
appearance  of  groups  of  vesicles,  principally  about  the  face, 
filled  with  clear  serum. 

What  are  the  causes  ? 

Febrile,  nervous,  and  digestive  disorders. 

What  are  the  symptoms? 

The  eruption  appears  in  the  form  of  small-sized  vesicles, 
containing  fluid,  varying  from  the  size  of  a  pin's  head  to  a  pea. 
The  disease  is  rarely  attended  with  constitutional  symptoms. 

What  is  the  treatment? 

Very  little  treatment  is  required.  A  mild,  saline  laxative 
may  be  given  for  a  few  days ;  and  if  the  pain  be  severe,  small 
doses  of  opium.  The  eruption  may  be  treated  with  zinc  oint- 
ment, powdered  oxide  of  zinc,  rose  powder,  or  flexible  collodion. 


Pemphigus. 


What  is  the  synonym  ? 

Water  blisters. 


What  is  the  definition  ? 

An  inflammatory  disease  of  the  skin,  characterized  by  the 
appearance  of  round  and  irregularly  shaped  blebs,  varying  in 
size  from  a  pea  to  a  large  walnut. 


208  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

What  are  the  causes  ? 

Usually  associated  with  a  low  state  of  the  system,  or  may  be 
syphilitic  in  origin. 

What  are  the  symptoms? 

First  a  patch  of  erythema  appears  upon  the  healthy  skin, 
which  may  be  bright-red  or  of  a  coppery  tint.  The  patch  be- 
comes slightly  raised  and  the  cuticle  becomes  partially  sepa- 
rated, giving  a  soft,  wrinkled  appearance.  After  this  bullae 
form  upon  a  slightly  vascular  base,  containing  serum  or  a  thin, 
puriform  fluid.  These  vesicles  rupture  and  dry  and  form  a 
crust.  All  parts  of  the  body  are  liable  to  be  affected.  Pem- 
phigus neonatorum  appears  as  scattering  bullae  on  various  parts 
of  the  body,  and  has  been  found  on  the  gums  and  mucous 
membrane  of  the  mouth. 

What  is  the  prognosis  ? 

Only  grave  in  young  infants. 

What  is  the  treatment  ? 

The  general  health  of  the  child  should  be  looked  after.  A 
thorough  study  of  the  cause  must  be  made,  and,  if  discovered, 
removed.  Internally,  quinine  and  arsenic  are  the  leading 
drugs.  The  blebs  should  be  punctured  and  evacuated.  Starch 
and  oxide  of  zinc  powder  or  dilute  Goulard's  cerate  should  be 
used  locally. 

Erythema  Simplex. 

What  is  the  definition  ? 

An  acute  affection  of  the  skin,  caused  by  an  abnormal  quan- 
tity of  blood  in  the  dermal  vessels. 

What  are  the  causes  ? 

Heat,  cold,  contact  with  irritants.  In  children  it  is  most 
frequently  caused  by  gastro-intestinal  disorders,  and  may  occur 
during  the  eruptive  fevers. 


"DISEASES    OF    THE    SKIN.  209 

What  are  the  symptoms  ? 

A  rapidlj  developed  redness  of  the  skin,  which  disappears 
upon  pressure  to  rapidly  return.  There  may  be  slight  itching 
and  burninof. 

What  is  the  treatment  ? 

Causal  factors  should  be  removed  and  the  eruption  treated 
with  any  of  the  simpler  dusting  powders,  such  as  lycopodium, 
oxide  of  zinc,  etc. 

Erythema  Intertrigo. 

What  is  the  definition  ? 

An  acute  congestion  of  the  skin,  characterized  by  redness, 
heat,  and  perspiration  of  the  parts. 

What  are  the  causes  ? 

In  infants  and  children  the  contact  of  a  wet  diaper  will 
cause  it,  also  gastro-intestinal  disorders. 

What  are  the  symptoms  ? 

Frequent,  where  the  folds  of  skin  come  in  contact,  as  the 
nates,  perineum,  and  groin.  The  parts  become  red,  hot,  and 
very  painful,  with  an  increased  flow  of  perspiration,  causing 
the  child  much  discomfort. 

What  is  the  treatment? 

The  parts  should  be  thoroughly  washed  with  pure  castile 
soap  or  bran-water,  and  carefully  dried  with  a  soft  towel  and 
dusted  with  any  of  the  simple  dusting  powders,  or  the  follow- 
ing may  be  used  : — 

R.     Hydrarg.  Chlor,  Mit.  gr.  xv. 
Vaseline  ^j- — M. 
Sig.  Use  locally. 


u 


210  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

SeborrhcEa. 

What  are  the  synonyms  ? 
Acne  ;  sebacea  ;  dandruff. 

What  is  the  definition? 

A  disorder  of  the  sebaceous  glands  of  the  skin,  characterized 
by  an  abnormal  secretion  of  sebaceous  matter. 

What  are  the  causes  ? 

Vernix  caseosa  in  newly-born  infants ;  anaemia  in  older 
children. 

What  are  the  symptoms? 

This  disease  may  appear  on  any  part  of  the  body,  but  it  is 
most  frequently  seen  upon  the  scalp  and  face.  It  appears  as  a 
greasy  coating  upon  the  skin,  unattended  with  inflammation  or 
itching,  leading  to  a  thick  caking  when  the  scalp  is  affected. 

What  is  the  treatment  ? 

The  crusted  material  must  be  softened  with  soap,  an  oily 
application,  or  poultices,  and  at  once  removed ;  the  part  should 
be  kept  scrupulously  clean  with  warm  water  and  castile  soap. 
In  older  children  the  hair  must  be  kept  short  and  frequently 
washed  with  soap  and  water,  and  the  scalp  stimulated  by  being 
frequently  brushed.  Carbolized  vaseline  prevents  the  accumu- 
lation of  the  natural  secretion  and  produces  a  healthy  condition 
of  the  affected  glands.  Boric  acid  in  glycerine  will  be  found 
of  service. 

Psoriasis. 

What  are  the  synonyms  ? 
Lepra  ;  dry  tetter. 

What  is  the  definition  ? 

A  chronic,  non-contagious  "disease,  characterized  by  slightly 
raised  red  patches  covered  with  scales. 


DISEASES    OF    THE    SKIN.  211 

What  are  the  causes  ? 

Not  known ;    may    be  hereditary.      Not  very  common  in 

children. 

What  are  the  symptoms  ? 

The  disease  may  appear  on  any  part  of  the  body,  and  begins 
as  small,  reddish  spots,  the  size  of  a  pin's  head,  which  at  once 
become  covered  with  whitish  scales.  These  spots  gradually 
increase  in  size,  forming  patches.  There  is  no  discharge,  and 
the  skin  between  the  patches  is  perfectly  healthy.  There  is 
intense  itching. 

What  is  the  prognosis  ? 

Relapses  are  common. 

What  is  the  treatment? 

The  general  health  should  be  carefully  looked  after,  and  the 
diet  regulated.  The  bowels  must  be  kept  open  with  saline 
laxatives.  Arsenic  should  be  given  in  full  doses  internally ; 
locally  the  parts  may  be  washed  with  tar  soap  to  remove  the 
scales,  or  alkaline  baths  may  be  given.  In  the  early  stage 
soothing  applications  should  be  used,  such  as  rubbing  the  parts 
with  olive  oil  twice  daily.  In  chronic  cases  the  following 
formulae  will  be  found  of  service  : — 

5.     Acid.  Chrysophanic.  gr.  x. 
Adipis  Benzoat.  f^j. — M. 
Sig.  Use  night  and  morning. 

R.     Ungt.  Picis  Liquidae, 

Ungt.  Sulpliuris  aa  ^ss. — M. 
Sig.  Use  locally. 

Scabies. 

What  is  the  definition  ? 

A  contagious  disease,  due  to  a  parasitic  insect  which  bur- 
rows under  the  skin. 


212  ESSENTIALS    OF    DISEASES    OF    CHILDKEN. 

What  are  the  causes  ? 

The  acaris  ;  direct  contagion. 

What  are  the  symptoms  ? 

The  disease  usually  attacks  the  hands  between  the  fingers, 
and  rarely  the  face,  but  no  part  of  the  body  is  exempt.  The 
eruption  is  in  the  form  of  papules,  vesicles,  and  pustules;  when 
the  parts  are  scratched,  from  the  intense  itching,  fissures,  torn 
vesicles,  etc.,  form. 

The  burrow  is  made  by  the  parasite  entering  beneath  the 
epidermis.  Scabies  may  often  be  complicated  with  eczema 
and  ecthyma. 

What  is  the  diagnosis  ? 

Only  sure  after  the  parasite  has  been  detected. 

What  is  the  treatment  ? 

The  child '  should  be  washed  thoroughly  in  a  warm  bath, 
with  plenty  of  common  brown  soap,  and  the  parts  well  rubbed 
with  either  of  the  following:  ointments  : — 


o 


'!fy.     Sulphur  Prsecip.  5ij« 
Potass.  Bicarb.  5j' 
Adipis  5j' — M. 


Sig. 
Or, 


Vf..     Sulphuris  5^3- 

Hjdrarg.  Ammon.  gr.  iv. 
Creasoti  TiXiv. 
01.  Antliemidis  TT|_x. 
Adipis  ^j. — M. 
Sig.  {Tilbury  Fox.) 

The  underclothes  should  be  changed,  and  the  infected  ones 
boiled  or  baked. 


DISEASES    OF    THE    SKIN.  213 

Tinea  Carcinata. 

Wliat  is  the  synonym  ? 

Ring-worm  of  the  body. 

What  is  the  definition? 

A  contagious  disease  of  the  skin,  due  to  the  parasite  trich- 
ophyton fungus. 

What  are  the  causes? 

The  parasite  above  mentioned ;  commonly  seen  in  ill-nour- 
ished, weakly  children. 

What  are  the  symptoms  ? 

The  disease  is  usually  of  a  trivial  form  in  children  ;  it  begins 
with  a  spot  of  papules,  and  in  the  course  of  a  few  days  assumes 
a  circular  form  about  an  inch  or  more  in  diameter. 

What  is  the  diagnosis  ? 

The  circular  form  of  the  eruption  makes  the  diagnosis  easy. 

What  is  the  treatment? 

Hyposulphite  of  sodium  used  in  strength  of  one  drachm  to 
the  ounce,  boracic  acid  dissolved  in  glycerine,  the  liniment  of 
iodine,  the  perchloride  of  iron,  citrine  ointment,  and  oleate  of 
mercury  are  all  of  value. 

Tinea  Tonsurans. 

What  is  the  definition  ? 

A  contagious,  parasitic  disease  of  the  scalp,  caused  by  the 
trichophyton  fungus. 

What  are  the  causes? 

The  presence  of  the  parasite  trichophyton  fungus,  or  direct 
contagion. 

What  are  the  symptoms  ? 

The  disease  begins  in  small,  circular  patches  ;  later  on  they 


214  ESSENTIALS    OF    DISEASES    OF    CHILDREN. 

become  small  vesicles  or  pustules,  which  desquamate.  The 
patches  vary  in  size  from  an  inch  to  nearly  two  in  diameter. 
There  may  be  slight  or  severe  itching. 

What  is  the  treatment  ? 

The  diseased  part  of  the  scalp  should  have  the  hair  closely 
shaved  and  the  part  washed  with  sapo  viridis  and  warm  water. 
If  tlie  disease  is  extensive  the  hair  should  be  cut  short  all  over 
the  head.  Dr.  Alder  Smith  recommends  the  following  oint- 
ment : — 

:^.     Acid.   Carbol.  (Calvert's  No.  2), 
Ungt.  Hydrarg.  Nitrat., 
Ungt.  Sulphuris,  aa  5j- — M. 
Sig.  Use  for  a  child  of  ten  years. 

In  children  over  the  age  of  ten  years  a  ten-per-cent.  solution 
of  the  oleate  of  mercury  may  be  used.  Dr.  Harrison,  of  Bris- 
tol, recommends  the  following  treatment :  The  hair  must  be 
cut  short  and  the  patches  painted  with  a  solution  of  equal  parts 
of  liquor  potassae,  rectified  spirits,  and  half  a  drachm  of  the 
iodide  of  potassium.  This  lotion  should  only  be  applied  to  the 
patches. 


INDEX. 


ABDOMEN,  examination  of,  19 
Abscess,  retro-pharyngeal,  41 
Acute  Briffht's  disease,  196 
bronchitis,  167 
gastric  catarrh,  43 

symptoms  of,  43 
diagnosis  of,  44 
treatment  of,  44 
infectious  diseases,  85 
laryngitis,  158 

symptoms  of,  159 
diagnosis  of,  159 
treatment  of,  159 
membranous  laryngitis,  164 
symptoms  of,  165 
diagnosis  of,  166 
treatment  of,  166 
nasal  catarrh,  157 
pharyngitis,  37 

symptoms  of,  37 
diagnosis  of,  38 
treatment  of,  38 
rheumatism,  115 
tonsillitis,  38 

symptoms  of,  39 
diagnosis  of,  39 
treatment  of,  39 
urticaria,  201 
Anaemia,  127 

symptoms  of,  127 
diagnosis  of,  128 
treatment  of,  128 
Anatomical   lesions  of  cholera  in- 
fantum, 59 
of  chronic  diarrhoea,  62 
of  entero-colitis,  55 
Anatomy,   morbid,   of  cirrhosis  of 
the  liver,  76 
of  congenital  hydrocepha- 
lus, 136 
of  diphtheria,  92 
of  rickets,  112 
of  sypliiljs,  121 
of  syphilitic  hepatitis,  78 


Anatomy  of  typhoid  fever,  105 
Anuria,  193 

symptoms  of,  194 

treatment  of,  194 
Aortic  valves,  diseases  of,  191 
Aphthous  stomatitis,  30 
course  of,  30 
symptoms  of,  30 
treatment  of,  30 
Apoplexy,  139 
Ascaris  lumbricoides,  treatment  of, 

72 
Ascites,  83 

symptoms  of,  83 

diagnosis  of,  84 

treatment  of,  84 
Atelectasis,  178 

symptoms  of,  178 

treatment  of,  179 
Auscultation,  19 


BOILS,  205 
Brain,  congestion  of,  151 
tumors  of,  138 
Bright's  disease,  pathological  anat- 
omy of,  196 
symptoms  of,  197 
diagnosis  of,  197 
treatment  of,  197 
Bromide  eruption,  206 
Bronchitis,  acute,  167 

symptoms  of,  169 
diagnosis  of,  168 
capillary,  171 

pathological    anatomy    of, 

171 
symptoms  of,  173 
diagnosis  of,  1 72 
treatment  of,  172 
chronic,  169 

symptoms  of,  170 
treatment  of,  170 


(215) 


216 


INDEX. 


CAPILLARY  bronchitis,  171 
Catarrhal  pneumonia,  173 
stomatitis,  28 

duration  of,  29 
symptoms  of,  29 
treatment  of,  29 
Cerebral  hemorrhage,  139 
symptoms  of,  139 
diagnosis  of,  139 
treatment  of,  139 
Chicken-pox,  96 

Child,  method  of  examining,  17 
new-born,  anatomical  peculiari- 
ties of,  24 
length  of,  24 
weight  of  new-born,  23 
Cholera  infantum,  58 

anatomical  lesions  of,  59 
symptoms  of,  59 
diagnosis  of,  60 
treatment  of,  60 
Chorea,  154 

symptoms  of,  154 
treatment  of,  155 
Chronic  bronchitis,  169 
diarrhoea,  61 
gastric  catarrh,  44 

symptoms  of,  45 
diagnosis  of,  45 
treatment  of,  46 
laryngitis,  160 

symptoms  of,  160 
treatment  of,  160 
Cirrhosis  of  the  liver,  75 

morbid  anatomy  of,  76 
symptoms  of,  76 
diagnosis  of,  77 
treatment  of,  77 
Cold  in  the  head,  157 
Colic,  49 

Congenital  heart  disease,  193 
hydrocephalus,  136 
symptoms  of,  136 
diagnosis  of,  137 
treatment  of,  137 
Congestion  of  the  brain,  151 
symptoms  of,  152 
diagnosis  of,  152 
treatment  of,  153 
Constipation,  49 

treatment  of,  50-52 
Convulsions,  145 

symptoms  of,  145 
diagnosis  of,  146 


Convulsions,  treatment  of,  147 
Coryza,  157 

symptoms  of,  157 
treatment  of,  157 
Countenance,  expression  of  indica- 
tive of  disease,  19 
Cretinism,  150 

symptoms  of,  151 
treatment  of,  151 
Croup,  true,  164 
Croupous  pneumonia,  176 
Cry,  character  of,  in  cerebral  dis- 
ease, 20 
in  croup,  20 
in  pneumonia,  20 
Crying,  obstinate,  20 


DENTITION,  25 
Diagnosis  of  ascites,  84 
of  acute  bronchitis,  168 

gastric  catarrh,  44 

laryngitis,  159 

pharyngitis,  38 

tonsillitis,  39 
of  anaemia,  128 
of  Bright's  disease,  197 
of  capillary  bronchitis,  172 
of  catarrhal  pneumonia,  174 
of  cerebral  hemorrhage,  139 
of  cholera  infantum,  60 
of  chronic  diarrhoea,  62 

gastric  catarrh,  45 
of  cirrhosis  of  the  liver,  77 
of    congenital    hydrocephalus, 

137 
of  congestion  of  the  brain,  152 
of  convulsions,  146 
of  croupous  pneumonia,  177 
of  diphtheria,  93 
of  dysentery,  65 
of  ecthyma,  205 
of  encephalic  tumors,  138 
of  entero-colitis,  56 
of  epilepsy,  148 
of  gangrenous  stomatitis,  36 
of  hgemophilia,  127 
of  infantile  paralysis,  140 
of  jaundice,  75 
of  laryngismus  stridulus,  162 
of  malarial  fever.  111 
of  measles,  86 
of  meningitis,  131 
of  parotitis,  101 


INDEX. 


217 


Diagnosis  of  peritonitis,  82 

of  pertussis,  103 

of  pleurisy,  18i 

of  pseudo-hypertrophic  paraly- 
sis, 143 

of  retro-pharyngeal  abscess,  42 

of  rheumatism,  116 

of  rickets,  113 

of  rotheln,  91 

of  scarlet  fever,  88 

of  spasmodic  laryngitis,  163 

of  syphilis,  121 

of  syphilitic  hepatitis,  79 

of  tabes  mesenterica,  120 

of  thrush,  34 

of  torticollis,  144 

of  tubercular  meningitis,  133 

of  tubercular  phthisis,  181 

of  typhoid  fever,  107 

of  ulcerative  stomatitis,  31 

of  variola,  98 
Diarrhoea,  53 

simple,  symptoms  of,  53 
treatment  of,  54 

chronic,  61 

anatomical  lesions  of,  62 
symptoms  of,  62 
diagnosis  of,  62 
treatment  of,  63 
Diathetic  diseases,  118 
Diphtheria,  92 

morbid  anatomy  of,  92 

symptoms  of,  93 

diagnosis  of,  93 

treatment  of,  94 
Diseases  of  the  aortic  valves,  191 

of  the  blood,  124 

of  the  genito-urinary  organs,  193 

of  the  liver,  74 

of  the  nervous  system,  130 

not  infectious,  110. 

of  the  organs  of  respiration,  157 

of  the  peritoneum,  81 

of  the  skin,  200 

of  the  spleen,  124 
Dosage,  24 
Dysentery,  64 

symptoms  of,  65 

diagnosis  of,  65 

treatment  of,  66 


ECTHYMA,  204 
diagnosis  of,  205 


Ecthyma,  symptoms  of,  204 

treatment  of,  205 
Eczema,  202 

symptoms  of,  202 
diagnosis  of,  203 
treatment  of,  203 
Encephalic  tumors,  138 

symptoms  of,  138 
diagnosis  of,  138 
treatment  of,  138 
Endocarditis,  188 

pathological  anatomy  of,  188 
symptoms  of,  188 
treatment  of,  189 
Entero-colitis,  55 

anatomical  lesions  of,  55 
symptoms  of,  55 
character  of  stools  in,  56 
diagnosis  of,  56 
treatment  of,  57 
Enuresis,  198 
Epilepsy,  147 

symptoms  of,  147 
diagnosis  of,  148 
treatment  of,  208 
Erythema  simplex,  208 


FALSE  croup,  163 
Fecal  evacuations,  21 
Flatulence,  49 
Furunculus,  205 

symptoms  of,  206 
treatment  of,  206 


GANGRENOUS  stomatitis,  35 
symptoms  of,  36 
diagnosis  of,  36 
treatment  of,  37 
Gastric  catarrh,  acute,  43 

chronic,  44 
Genito-urinary  organs,  diseases  of, 

193 
German  measles,  91 
Gestures  indicative  of  disease,  20 
Gums,  examination  of,  19 


H 


^MATURIA,  193 

Haemophilia,  126 

symptoms  of,  126 

diagnosis  of,  127 

treatment  of,  127 


218 


INDEX. 


Heart  disease,  congenital,  192 

valvular  diseases  of,  189 
Herpes,  207 

symptoms  of,  207 

treatment  of,  207 
Hydrocephalus,  135 

pathological  anatomy  of,  135 

symptoms  of,  135 

treatment  of,  135 
Hypertrophy  of  the  tonsils,  40 
symptoms  of,  40 
treatment  of,  41 


ICTERUS  neonatorum,  70,  74 
Idiocy,  149 
symptoms  of,  150 
treatment  of,  150 
Impetigo,  204 

symptoms  of,  204 
treatment  of,  204 
Incontinence  of  urine,  198 
Infantile  paralysis,  140 

symptoms  of,  140 
diagnosis  of,  140 
treatment  of,  141 
Intussusception,  67 
symptoms  of,  67 
treatment  of,  68 


JAUNDICE,  74 
symptoms  of,  74 
diagnosis  of,  75 
treatment  of,  75 


LARYNGISMUS  stridulus, 
symptoms  of,  161 
diagnosis  of,  162 
treatment  of,  162 
Liver,  cirrhosis  of,  75 
diseases  of,  74 


MALARIAL  fever,  110 
symptoms  of,  110 
diagnosis  of.  111 
treatment  of,  111 
Measles,  85 

symptoms  of,  85 
diagnosis  of,  86 
treatment  of,  86 
Meningitis,  130 


161 


Meningitis,  diagnosis  of,  131 

pathological  anatomy  of,  130 

symptoms  of,  131 

treatment  of,  133 

tubercular,  132 
Miliaria,  200 

symptoms  of,  200 

treatment  of,  200 
Milk  teeth,  25 
Mitral  obstruction,  190 

regurgitation,  189 
Morbilli,  85 
Mumps,  101 


NIGHT  mare,  149 
terror,  149 
symptoms  of,  149 
treatment  of,  149 
Nocturnal    incontinence    of  urine, 

198 
Noma,  35 


AXYURIS  vermicularis,  71 


PARALYSIS,  infantile,  140 
stomatitis,  32 
Parotitis,  101 

diagnosis  of,  101 
symptoms  of,  101 
treatment  of,  102 
Pathological   anatomy  of   Bright's 
disease,  196 
of  capillary  bronchitis,  171 
of  catarrhal  pneumonia,  173 
of  croupous  pneumonia,  176 
of  endocarditis,  188 
of  hydrocephalus,  135 
of  meningitis,  130 
of  pleurisy,  183 
of  thrush,  33 

of  tubercular    meningitis, 
132 
phthisis,  179 
Pemphigus,  207 

symptoms  of,  208 
treatment  of,  208 
Percussion,  19 
Pericarditis,  187 
Permanent  teeth,  26 
Peritoneum,  diseases  of,  81 


INDEX. 


219 


Peritonitis,  81 

symptoms  of,  81 
diagnosis  of,  82 
treatment  of,  83 
Pertussis,  102 

symptoms  of,  103 

diagnosis  of,  103 

treatment  of,  103 

Pharyngitis,  acute,  37 

Phthisis,  tubercular,  179 

pathological    anatomy    of, 

179 
symptoms  of,  180 
diagnosis  of,  181 
treatment  of,  181 
Pleurisy,  83 

pathological  anatomy  of,  183 
symptoms  of,  183 
diagnosis  of,  184 
treatment  of,  18-4 
Pneumonia,  catarrhal,  173 

pathological    anatomy    of, 

173 
symptoms  of,  174 
diagnosis  of,  174 
treatment  of,  175 
croupous,  176 

pathological    anatomy    of, 

176 
symptoms  of,  176 
diagnosis  of,  177 
treatment  of,  178 
Pseudo-hypertrophic  paralysis,  143 
symptoms  of,  143 
diagnosis  of,  143 
treatment  of,  143 
Psoriasis,  210 

symptoms  of,  211 
treatment  of,  211 
Pulse,  the,  33 
Pupils,  contracted,  31 
Purpura,  125 

symptoms  of,  125 
treatment  of,  136 
Pyuria,  194 

symptoms  of,  194 
treatment  of,  194 


RENAL  calculus,  195 
symptoms  of,  195 
treatment  of,  196 
Rcspiratif)!!  at  different  ages,  18 
Retro-pharyngeal  abscess,  41 


Retro-pharyngeal     abscess,    symp- 
toms of,  43 
diagnosis  of,  43 
treatment  of,  42 
Rheumatism,  115 

symptoms  of,  115 

diagnosis  of,  116 

treatment  of,  116 
Rickets,  111 

morbid  anatomy  of,  113 

symptoms  of,  113 

diagnosis  of,  113 

treatment  of,  113 
Ring  worm,  313 
Rotheln,  91 

symptoms  of,  91 

diagnosis  of,  91 

treatment  of,  91 


SALIVA,  secretion  of,  30 
Scabies,  311 
Scarlet  fever,  86 

varieties  of,  87 
symptoms  of,  87 
diagnosis  of,  88 
treatment  of,  88 
Scrofula,  118 

symptoms  of,  118 
treatment  of,  118 
Scrofulous  kidney,  194 
Seborrhoea,  310 

treatment  of,  310 
Second  dentition,  treatment  during, 

26 
Simple  diarrhcea,  53 
Skin,  diseases  of,  300 
Sleep,  18 
Smallpox,  96 
Spasm  of  the  glottis,  161 
Spasmodic  laryngitis,  161 
symptoms  of,  163 
diagnosis  of,  163 
treatment  of,  164 
Spastic  rigidity,  144 

symptoms  of,  144 
treatment  of,  145 
Spinach  stool,  32 
Squinting,  30 
Stiff  neck,  143 
Stomach,  ulcer  of,  47 
Stomatitis,  aphthous,  30 
catarrhal,  38 
gangrenous,  35 


220 


INDEX. 


Stomatitis,  parasitic,  33 

ulcerative,  30 
Stools,  character  of,  in  entero-coli- 

tis,  56 
St.  Vitus's  dance,  154 
Symptoms  of  acute  bronchitis,  168 

gastric  catarrh,  43 

laryngitis,  159 

membranous  laryngitis,  165 

pharyngitis,  37 

tonsillitis,  39 
of  anaemia,  127 
of  anuria,  194 
of  aphthous  stomatitis,  30 
of  ascites,  83 
of  atelectasis,  178 
of  boils,  206 
of  Bright's  disease,  197 
of  capillary  bronchitis,  172 
of  catarrhal  pneumonia,  174 

stomatitis,  29 
of  cerebral  hemorrhage,  139 
of  cholera  infantum,  59 
of  chorea,  154 
of  chronic  bronchitis,  170 

diarrhoea,  42 

gastric  catarrh,  45 

laryngitis,  160 
of  cirrhosis  of  the  liver,  76 
of   congenital    hydrocephalus, 

136 
of  congestion  of  the  brain,  153 
of  convulsions,  146 
of  coryza,  157 
of  cretinism,  151 
of  croupous  pneumonia,  176 
of  diphtheria,  93 
of  dysentery,  65 
of  ecthyma,  204 
of  eczema,  202 
of  encephalic  tumors,  138 
of  endocarditis,  188 
of  entero- colitis,  55 
of  epilepsy,  147 
of  gangrene  stomatitis,  36 
of  hgematuria,  193 
of  herpes,  207 
of  hydrocephalus,  135 
of  hypertrophy  of  the  tonsils,  40 
of  idiocy,  150 
of  impetigo,  204 
of  infantile  paralysis,  140 
of  intussusception,  67 
of  jaundice,  74 


Symptoms   of  laryngismus  stridu- 
lus, 161 

of  malarial  fever,  110 

of  measles,  85 

of  meningitis,  131 

of  miliaria,  300 

of  night  terror,  149 

of  parotitis,  101 

of  pemphigus,  208 

of  peritonitis,  81 

of  pertussis,  102 

of  pleurisy,  183 

of  pseudo-hypertrophic  paraly- 
sis, 142 

of  purpura,  125 

of  pyuria,  194 

of  renal  calculus,  195 

of  retro-pharyngeal  abscess,  43 

of  rheumatism,  115 

of  rickets,  113 

of  rbtheln,  91  * 

of  scarlet  fever,  87 

of  scrofula,  118 

of  simple  diarrhcea,  53 

of  spasmodic  laryngitis,  163 

of  spastic  rigidity,  144 

of  syphilis,  130 

of  syphilitic  hepatitis,  79 

of  tabes  mesenterica,  119 

of  thrush,  33 

of  tubercular  meningitis,  133 
phthisis,  180 

of  typhoid  fever,  106 

of  ulcer  of  the  stomach,  47 

of  ulcerative  stomatitis,  31 

of  urticaria,  301 

of  varicella,  96 

of  variola,  97 
Syphilis,  130 

symptoms  of,  130 

diagnosis  of,  121 

treatment  of,  133 
Syphilitic  hepatitis,  78 

symptoms  of,  79 
diagnosis  of,  79 
treatment  of,  79 


TABES  MESENTERICA,  119 
symptoms  of,  119 
diagnosis  of,  120 
treatment  of,  120 
Taenia  solium,  70 
Tears,  secretion  of,  20 


INDEX. 


221 


Teething,  treatment  during,  25 
Temperature,  the,  23 
Throat,  examination  of,  18 
Thrush,  32 

pathological  anatomy  of,  33 
symptoms  of,  33 
diagnosis  of,  34 
treatment  of,  34 
Tinea  carcinata,  213 

symptoms  of,  213 
treatment  of,  213 
tonsurans,  213 

treatment  of,  214 
Tongue,  altered  conditions  of,  21 

examination  of,  18 
Tonsils,  hypertrophy  of,  40 
Tonsillitis,  38 
Torticollis,  143 

diagnosis  of,  144 
treatment  of,  144 
Treatment  of  acute  bronchitis,  169 
of  acute  gastric  catarrh,  44 
laryngitis,  159 
membranous  laryngitis,  166 
pharnygitis,  38 
tonsillitis,  39 
of  anaemia,  128 
of  anuria,  194 
of  aphthous  stomatitis,  30 
of  ascaris  lumbricoides,  73 
of  atelectasis,  179 
of  boils,  206 
of  Bright's  disease,  197 
of  bromide  eruption,  207 
of  capillary  bronchitis,  172 
of  catarrhal  pneumonia,  175 

stomatitis,  29 
of  cerebral  hemorrhage,  139 
of  cholera  infantum,  60 
of  chorea,  155 
of  chronic  bronchitis,  170 
diarrhoea,  63 
catarrh,  46 
laryngitis,  160 
of  cirrhosis  of  the  liver,  77 
of  colic,  49 
of    congenital    hydrocephalus, 

137 
of  congestion  of  the  brain,  153 
of  constipation,  50-52 
of  convulsions,  147 
of  coryza,  157 
of  cretinism,  151 
of  croupous  pneumonia,  178 


Treatment  during  teething,  25 
of  diphtheria,  94 
of  dysentery,  66 
of  ecthyma,  205 
of  eczema,  203 
of  encephalic  tumors,  138 
of  endocarditis,  189 
of  entero-colitis,  57 
of  epilepsy,  148 
of  flatulence,  49 
of  gangrenous  stomatitis,  37 
of  haematuria,  193 
of  haemophilia,  127 
of  herpes,  207 
of  hydrocephalus,  135 
of  hypertrophy  of  the  tonsils,  41 
of  icterus  neonatorum,  74 
of  idiocy,  150 
of  impetigo,  204 
of  incontinence  of  urine,  198 
of  infantile  paralysis,  141 
of  intussusception,  68 
of  jaundice,  75 
of  laryngismus  stridulus,  162 
of  malarial  fever,  111 
of  measles,  86 
of  meningitis,  132 
of  miliaria,  200 
of  night  terror,  149 
of  oxyuris  vermicularis,  71 
of  parotitis,  102 
of  pemphigus,  208 
of  peritonitis,  82 
of  pertussis,  103 
of  pleurisy,  184 

of  pseudo-hypertrophic  paraly- 
sis, 143 
of  purpura,  126 
of  pyuria,  194 
of  renal  calculus,  196 
of  retro-pharyngeal  abscess,  42 
of  rheumatism,  116 
of  rickets,  113 
of  rotheln,  91 
of  scarlet  fever,  88 
of  scrofula,  118 
of  scrofulous  kidney,  195 
of  simple  diarrhoea,  54 
of  spasmodic  laryngitis,  164 
of  spastic  rigidity,  145 
of  syphilis,  122 
of  sy[)hilitic  hepatitis,  79 
of  tabes  mesenterii-a,  120 
of  tieniu  solium,  72 


222 


INDEX. 


Treatment  of  thrush,  34- 
of  tinea  carcinata,  213 

tonsurans,  214 
of  torticollis,  M4 
of  tubercular  meningitis,  134 

phthisis,  181 
of  typhoid  fever,  107 
of  ulcer  of  the  stomach,  47 
of  ulcerative  stomatitis,  32, 
of  urticaria,  202 
of  varicella,  96 
of  variola,  98 
of  vomiting,  48 
True  croup,  164 
Tubercular  meningitis,  132 

pathological    anatomy    of, 

132 
symptoms  of,  133 
diagnosis  of,  133 
treatment  of,  134 
phthisis,  179 
Tumors  of  the  brain,  138 
Typhoid  fever,  105 

morbid  anatomy  of,  105 
symptoms  of,  106 
diagnosis  of,  107 
treatment  of,  107 


ULCER  of  stomach,  47 
symptoms  of,  47 


Ulcer  of   stomach,  treatment  of, 

47 
Ulcerative  stomatitis,  30 
symptoms  of,  31 
diagnosis  of,  31 
treatment  of,  32 
Urine,  incontinence  of,  198 
Urticaria,  201 

symptoms  of,  201 
treatment  of,  202 


VACCINATION,  100 
Vaccinia,  100 
Valvular  diseases  of  the  heart,  189 
Varicella,  96 

symptoms  of,  96 

treatment  of,  96 
Variola,  96 

varieties  of,  97 

symptoms  of,  97 

diagnosis  of,  98 

treatment  of,  98 
Vomiting,  22-48 


WEIGHT  of  new-born  child,  23 
Whooping-cough,  102 
Worms,  varieties  of,  69 
Wry  neck,  143 


NOW  READY. 

SYLLABUS  OF  OBSTETRICAL 
LECTURES 

IN    THE    MEDICAL    DEPARTMENT, 

UNIVERSITY  OF  PENNSYLVANIA. 
BY 

DEMONSTRATOR  OF  OBSTETRICS  IN  THE  UNIVERSITY 
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and  Hospital;  Gynaecologist  to  St.  Mark's  Hospital  In  New  York 

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READY   SHORTLY. 

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SAUNDERS'  QUESTION-GOMPENDS. 


Ji. 


OPINIONS  OF  THE  PRESS. 


Extract  from  Medical  Brief,  St.  Louis,  May^  1890. 

Semple's  Legal  Medicine  Toxicology  and  Hygiene.  "A  fair  sample  of 
Saunders' valuable  conipends  for  the  student  and  practitioner.  It  is  hand- 
somely printed  and  illustrated,  and  concise  and  clear  in  its  teachings." 

Extract  from  Southern  Practitioner,  April,  1890. 

Stelwagon's  Disease  of  the  Skin.  "The  subject  is  as  tersely  and  briefly 
considered  as  is  compatible  with  learners,  and  as  a  means  of  refreshing  the 
memory  or  permanently  fixing  therein  the  most  important  facts  of  Derma- 
tology, it  will  till  an  important  place  with  students  of'mediclne." 

Extract  from  Medical  and  Surgical  Reporter,  April.^  1890, 

Craigin's  Essentials  of  Gynfecology.  "This  is  a  most  excellent  addition  to 
this  series  of  question  compends^  and  properly  used  will  be  of  great  assist- 
ance to  the  student  in  preparing  for  examination.  Dr.  Craigin  is  to  be  congratu- 
lated upon  having  produced  in  compact  form  the  Essentials  of  Gynaecology. 
The  style  is  concise,  and,  at  the  same  time  the  sentences  are  well  rounded. 
This  rejiders  the  book  far  more  easy  to  i-ead  than  most  compends  and  adds  dis- 
tinctly to  its  value." 

Extract  from  the  New   York  Medical  Journal,  May,  1890. 

Stelwagon's  Diseases  of  the  Skin.  "We  are  indebted  to  Philadelphia. for 
another  excellent  book  on  Dematology.  The  little  book  now  before  us  is  well 
entitled  "Essentials  of  Dermatology,"  and  admirably  answers  the  i>urpose  for 
which  it  is  written.  The  experience  of  the  reviewer  has  taught  him  that 
just  such  a  book  Is  needed.  SVe  are  pleased  with  the  handsome  appearance 
of  the  book,  with  its  clear  type  and  good  paper,  and  would  specially  com- 
mend the  woodcuts  that  illustrate  the  text." 

Extract  from   Journal  of  Cutaneous  and  Getiito-Urinary  Diseases,  May  1890. 

"  An  examination  of  the  manuals  before  lis  cannot  fall  to  convince  one 
that  the  authors  have  done  their  work  in  a  satisfactory  manner. 

"Dr.  Stelwagon's  Essentials  of  Diseases  of  the  Skin  is  an  admirable  com- 
pend  of  our  knowledge  of  Dermatology.  The  author's  experience  as  a  teacher 
has  enaljled  him  to  formulate  questions  covering  all  essential  points,  while  the 
answers  are  comprehensive  with  sufficient  accuracy  of  detail  to  be  thoroughly 
intelligible.  Of  especial  value  and  comj)leteness  is  the  therapeutical  part  of 
the  work. 

"Dr.  Wolff  in  the  Ex;ami nation  of  the  Urine,  has  given  an  account  of  the 
normal  and  pathological  constituents  of  the  urine  and  a  resume  of  the  I'ecent  and 
inost  improved  methods  for  its  chemical  and  microscopical  examination.  The 
iniportance  of  a  knowledge  of  urinology  and  urinalysis  to  the  student  ot  derma- 
tology and  genito-urinai-y  diseases  cannot  too  strongly  be  insisted  on." 

"Dr.  Craigin  in  his  Essentials  of  Gynaecology  embraces  many  morbid  con- 
ditions of  much  interest  to  the  specialist  in  cutaneous  and  genito-urinary  dis- 
eases, as  the  skin  diseases  alfccting  the  vulva,  new  growths  of  the  vulva,  the 
arious  forms  of  vulvitis,  vaginitis  ui-ethritis,  endometritis,  salpingitis,  ovarttis, 
'Ic,  which  occur  as  .segueke  of  gonorrhceal  inflammation." 

Extract  frotn   Boston  Medical  and  Surgical  Journal,  May  i,  1890. 

"Craigin's  Gynaecology,  a  little  book  that  does  contain  the  essentials  of  gynse- 
cology  and  may  be  recrim  rmMuied  f-o  1  he  h\  ndont  as  a  safe  and  useful  guide  to  him 
in  liis  studies.''^ 


SAUNDERS' QUESTION-GOMPENDS. 


OPINIONS  OF  THE  PRESS. 

Extract  from  London  Lancet,  July  6tli,  1889. 


£ar£ka  St^nAcni^  that 


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June.  1889. 


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"  Wolff's  CnKMiSTUV. — A  littlo  bofik  tlutt  exj)l:iJnH,  clearly  and  simply,  the  most 
difficult  [fointrt  in  Medical  Cln-iMist,ry,  ho  U);it  ihU  n^orj  mi'k/D^^  ]jo*iAiKf^^nMC\fit^ify&.r 
of  a  medical  student's  elfortfi." 


